Inspection on 16/05/07 for Bedhampton Nursing Home

This inspection was carried out on 16th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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.

Other inspections for this house

Bedhampton Nursing Home 06/02/07

Bedhampton Nursing Home 13/02/06

Bedhampton Nursing Home 08/08/05

Bedhampton Nursing Home 03/02/05

Bedhampton Nursing Home 20/04/04

Bedhampton Nursing Home 11/11/02

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bedhampton Nursing Home 55 Hulbert Road Bedhampton Havant Hampshire PO9 3TB Lead Inspector Jan Everitt Unannounced Inspection 16 May 2007 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 Bedhampton Nursing Home DS0000011476.V336127.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. Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bedhampton Nursing Home Address 55 Hulbert Road Bedhampton Havant Hampshire PO9 3TB (023) 92 475125 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) Cheer Health Limited Mrs Lindsey Janet Gurney Care Home 30 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (30), of places Physical disability over 65 years of age (30), Terminally ill over 65 years of age (30) Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th February 2007 Brief Description of the Service: Bedhampton Nursing Home is residential Care Home for older persons. It is registered to accommodate 30 individuals over the age of 65 years who require nursing care. It is situated in a residential area close to local amenities and is accessible by train and local bus services. It was a family residence that has been extended. There is a mature garden to the rear of the home. Car parking space is available at the front. Potential residents and/or their representatives are invited to visit the home and view the premises. They are provided with a residents Guide that contains information about the service that the home provides. They are also advised to visit and view other homes in order that they can compare and make an informed choice about whether to move in. The residents guide includes a reference to the availability of the most recent reports of inspections of the home conducted by the Commission for Social Care Inspection (CSCI). Copies of these reports are kept in the entrance hall to the home. Fees currently range from £513 to £895 and this did not include the cost of hairdressing, chiropody treatment and newspapers and magazines. Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site inspection visit to Bedhampton Nursing Home, which was unannounced, took place over a one-day period on the 16th May 2007 and was attended by one inspector who was assisted throughout the visit by the manager, Mrs. Gurney. The visit to the home formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The provider had returned the Annual Quality Assurance Assessment to the CSCI and the focus of this visit to the home was to support the information stated in this document and other information received by the CSCI since the last fieldwork visit made to the home on the 6th February 2007. A number of comment survey cards were distributed to relatives prior to the visit of which three were returned. They were very positive in their comments about the care and services in the home. Two of the service users’ surveys were returned to the CSCI. Further evidence was gathered on the day of the site visit. The inspector toured the home and spoke to staff, residents and a relative who gave their views on the service. Residents in general stated that they enjoyed living at the home and considered the staff kind. Care records and other documentation identified in the report were viewed. At the time of this visit the home was accommodating 25 residents and of these, 7 were male and 18 were female and their ages ranged from 69 to 101 years. There were no service users needing specific identified cultural needs at the time of this visit. What the service does well: The manager undertakes a comprehensive pre-admission assessment, which would allow the home to ensure that the needs of that person could be met. Detailed assessments and care records are maintained and would give nursing and care staff detailed information about the resident and would enable them to provide the help and assistance that the service user needed. Residents said that they ‘felt safe and confident that the staff care for them properly’ and that they felt respected. Residents’ health care is promoted through regular assessment and monitoring and the home has good working relationships with the primary health team, Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 6 from whom they ask advise and are able to refer to healthcare specialists if necessary. Residents and relatives described the staff group as friendly and relationships between staff and residents were observed to be relaxed and informal. Daily routines in the home are flexible and residents are encouraged to make choices and have autonomy over their lives and how they wish to undertake their activities of daily living. The activities programme is tailored around the residents’ needs and preferences and their voice is listened to and acted upon. Regular residents’ meetings are held. Residents were complimentary about the food that the home provided and stated that they have choices at every mealtime. The home and environment is well maintained and clean with all areas accessible to residents. The surrounding gardens are well maintained and are a pleasant outlook for residents and a safe environment for those residents who wish to sit in the garden in the more pleasant weather. Residents voiced their satisfaction with their accommodation and most had made their personal space individual with pictures and personal belongings. Staff, residents and relatives had confidence in the effectiveness of the home’s manager. Systems and procedures in the home worked well including, the management of medication, dealing with complaints, staff recruitment, quality monitoring, and health and safety. There is a strong commitment to staff training and development to ensure that staff are able to fulfil their roles and responsibilities and meet residents needs. Comments received from the relatives on the surveys returned to the CSCI include: ‘As well as the home giving excellent care to the residents, family and friends are always made welcome’. ‘The home is continually making improvements and they can do no more’. ‘The residents feel that the is home their home and they are one big family’. ‘The staff demonstrate commitment, expertise, conviviality and a strong sense of humour towards residents who invariably respond in kind’. Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 7 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. Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. 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. Prospective service users have their care needs assessed prior to admission to the home to ensure the home can meet their needs. St 6 is not applicable to this service. EVIDENCE: The inspector viewed a sample of four service user’s care plans and records. There was evidence in three of the four files of a comprehensive assessment of the prospective service user’s care and health needs being undertaken prior to admission. The assessment was completed in detail and allowed all potential care and health needs to be identified during this process. Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 10 The manager explained that a service user who was not assessed by her, prior to moving into the home, had been an out of county referral and the information about this person was gathered from the care manager and other sources before the decision was made that the home could meet this person’s care needs. The manager or senior nurse undertakes all the pre-admission assessments. A relative spoken to confirmed that the manager had attended the hospital, in which her father was a patient, and that she had participated in the assessment process and had been able to supply information about his medical condition and about the other professionals involved in his care. Relatives, and if possible the prospective resident, are encouraged to visit the home prior admission and at that time are supplied with the residents guide which documents details of the home to enable people to make informed choices about whether they wish to move into this home. A relative told the inspector that she had chosen Bedhampton Nursing Home after she had read the report and the service user’s guide and had viewed two other homes in the area and now ‘felt at peace and confident that her father would be well cared for now that he had arrived at the home’. There was documentary evidence that assessments of residents needs were reviewed regularly and revised as necessary when an individual’s circumstances had changed. The home does not provide intermediate care. Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, & 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home had systems in place to ensure the personal and healthcare needs of residents are met. Policies and procedure are followed for the safe management of medication. Staff working practices helped to ensure that residents’ privacy and dignity is promoted at all times. EVIDENCE: The inspector received the Annual Quality Assurance Assessment (AQAA) from the providers, which was comprehensively completed. It stated that the home has a proactive approach from the point of admission and ensures that resident’s individual nursing and other care needs are met in a meaningful way. Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 12 This was evidenced when the inspector viewed the same sample of four service user’s care plans. They identified assessments for a range of potential risks to residents e.g. pressure sores; falls; moving and handling; malnutrition; etc. Where weight loss or eating difficulties had been identified as a problem for an individual, specific plans for that person included ensuring that their diet was supplemented and enhanced if required and their food and fluid intake was carefully monitored. The inspector observed that food and fluid charts were in evidence and that they were being completed appropriately. The home had also implemented a strategy to ensure that where individuals needed help/assistance with feeding that they could be easily identified. The staff spoken to were aware of the residents who needed assistance and this was observed to be undertaken by the staff in an unobtrusive and courteous manner. Service users assessed as being at risk of tissue breakdown were supplied with pressure relieving mattresses, that the manager reports, she has no problem in obtaining through a supplier if there are not sufficient available at the time. Individuals’ health is monitored on admission and regularly e.g. weight, blood pressure and temperature. The plans examined also set out clearly the actions staff had to take and what specialist equipment was needed to provide the support and assistance each person required. There was evidence from documentation and discussion with residents and relatives that wherever possible individuals and/or their representatives had been involved in developing the plans and agreed with the contents. Records indicated that care plans were reviewed at least monthly and daily notes referred to the actions taken by staff to provide the needs set out in those plans Staff spoken with at the time reported that the care plans are referred to regularly to enable them to know how to care for the residents and the information informs their practices. Service users spoken with at the time of this visit were complimentary about staff and reported that they consider they are ‘cared for wonderfully’. The inspector observed the communication and relationships between the staff and residents and concluded that staff are caring and respectful when interacting with residents. The inspector observed one lady being hoisted from her chair to her wheelchair and this task was being undertaken in the lounge area, where other residents were sitting, with screens around the lady’s chair and a blanket over her legs to maintain her dignity and privacy. Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 13 Care plans examined were not simply task focussed but included references to the fundamental principles that underpin social and health care such as privacy, dignity and choice and entries in plans illustrating this included the following: • “When using toilet close door behind her to ensure privacy” • “Cover with blanket to keep warm and to ensure dignity maintained” • “Use screen in shared room” There was evidence in the care plans examined that a separate record is kept of other visiting professionals to whom the residents have been referred. This includes GPs, tissue viability nurse, community psychiatric nurse, dietician, chiropodist, optician and all arranged out patient appointments are also documented. A recently admitted resident was being visited by the palliative care nurse at the time of this visit and the manager reported that she has no hesitation in asking for support from other professionals. Care managers do attend the home to review resident’s placements and the manager reported that when these are undertaken is dependant on the changing care needs of the resident. The nursing assessment team assess residents for the level of nursing care needed and this includes their continence assessment, for which aids are supplied. The home had written policies and procedures for the management and administration of medication. The inspector observed part of the medicine round and the registered nurse followed the procedures for safe practice. Medication is kept in locked and secured medicine trolleys, cupboards and where required in a medical refrigerator. Registered nurses are responsible for the management and administration of medication on a day-to-day basis. They have attended an update for medication by the local pharmacist. The manager reported that it is difficult to access training updates for the management of medication. The home’s manager had attended a “train the trainer” course organised by the adult and older persons service of the local authority in “the management of medication”. She has disseminated this training to the care staff to enable them to have a better understanding of how important it is that policy and procedures are following when managing medication. Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 14 The certificates for this training were seen in the staff training files and they had signed to confirm their understanding of their role and the parameters within which they work, when assisting with medication. The home has secure and appropriate storage facilities for controlled drugs. The inspector viewed the controlled drug register. This had been recorded appropriately. The records for the dispensing of the night sedation is maintained in this register and these drugs are accounted for daily from one shift to the next. A monitored dosage system for the management of medication was operated by the home. A local pharmacist provided most prescribed medication every 28 days in blister packs for each person concerned. Other medicines that could not be put into these packs because they could spoil, such as liquids or those that were to be taken only when required were dispensed from their original containers. The home promotes the independence of residents and those residents wishing to manage their own medication are able to do so if they have been risked assessed to be able to. At the time of this visit there were no residents wishing to self-medicate. The inspector observed that each room has a locked facility if the resident wished to store their valuables or if they were managing their medication. Good practice noted during the fieldwork visit included: • Recording the temperature of the refrigerator used for storing some medication • Dating of containers of certain medications when they were opened because of limited shelf lives i.e. eye-drops and thyroxin • Sample copies of the signatures of the Registered General Nurses that dispensed medication • Some sedative medication was treated as if it was a Controlled Drug • Copies are being kept of all medical alerts received by the home • The prescriptions are checked before they are sent to the pharmacist to be dispensed. The home has only three shared bedrooms and these were all provided with screens. Consequently the privacy of vast majority of residents was promoted by the fact that they were accommodated in single rooms. The inspector observed throughout the visit that staff were being courteous and respecting service user’s privacy by knocking on their doors before going in. Residents spoken to described the staff as respectful and polite. Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a stimulating activities programme that meets the needs of the service users in residence. Service users are able to maintain contact with friends and family and are able to go out into the community if they wish to. Service users are encouraged to maintain control over their lives and make choices in their activities of daily living. The home provides a varied and nutritious diet that allows service users to exercise their rights to choice and preferences. EVIDENCE: The inspector observed that there was a varied programme of activities for every day of the week, which was displayed on the wall in the reception area. The activities included: Bingo; reminiscence; music and movement; art works; baking; sing-a-long; board games; and manicures. The AQAA documents that the outcomes from the residents meetings and questionnaires completed by the residents, provides the manager with information on areas of interest, entertainment and activities and this together Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 16 with the personal aims and preferences allows the activities programme to be tailored around the needs of the service users. The manager reports that ideas discussed at the resident’s meeting has been implemented and enjoy a good deal of success. The record of the resident’s meetings were viewed by the inspector and these supported that various activities had been added to the programme as a result of the meetings and had subsequently resulted in a harpist visiting the home, which had been enjoyed by the residents. The animals from Millers’ Ark had also visited at Easter and the manager reported this to be a great success. One service user had a particular interest in birds and a speaker attended the home from the wild bird sanctuary to give a talk about birds. At the time of this site visit there were no programmed activities taking place but there were a number of visitors taking tea with the residents and the manager reported that most days there are sufficient staff to allow them to have time to talk to the residents individually. Residents’ religious preferences are documented in their care plans. The AQAA recorded that 24 of the residents were of a Christian denomination. One resident was of the Jewish faith but was choosing not to practice her faith. The manager reported that the home would respect her religious beliefs and accommodate specific needs, if she chose to practice. The home does not have a regular church service but a local clergy visit the home to give Holy Communion to those service users who have requested this. The residents spoken to indicated that they enjoyed the activities that were organised. The inspector observed when viewing the care plans that each service user has a social profile, which records some of their previous life styles and their past interests and hobbies. The care plan also records their preferences for how they wish to live their daily routines. Service users spoken to confirm that they are able to live their lives how they wish, daily routines are flexible and their wishes respected. The visitor’s book demonstrated regular visitors to the home and the manager reported that there are no restrictions on visiting times. The relatives’ surveys returned to the CSCI confirmed that visitors are made welcome and comments returned were: ‘Visitors are always made welcome and treated with cordiality’. ‘Family and friends are always made welcome’. ‘We visit daily and enjoy the pleasant, relaxed atmosphere of the home and the magnanimity of the staff’. Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 17 The inspector viewed a sample of the menus. The manager reported that the menus are in the process of being changed to reflect a more seasonal approach. Food and menus are always high on the agenda at the resident’s meetings and the menus will reflect what has been suggested or requested by residents. Food preferences, dislikes, food related allergies and nutritional and dietary requirements are recorded in residents’ care plans and the information is also readily available to catering staff and recorded for the cook to refer to. The menus and records of food provided indicated that the food was nutritious and there was a wide range of meals provided with a selection of choices every day. In addition special diets and individual preferences and needs were catered for e.g. soft and pureed meals and diabetics. The inspector spoke to the cook who showed the inspector the records of what each service user had eaten each day. One resident always chooses something different and special provision is made to meet his requests. All residents are asked what choices they want from the menu a day in advance. The residents spoken to were complimentary about the food provided and confirmed that they had 3 meals a day and could have snacks and drinks at other times. Fresh fruit and fluids were observed to be readily available in the home’ communal rooms. Residents could choose where to eat and some preferred to eat in their rooms. The dining area is pleasant but not used fully. The manager reported that the home is awaiting the arrival of new dining furniture, which may encourage the service users to use the area more regularly. The main meal of the day was observed and it was unhurried and staff were sensitive when providing assistance. The home had implemented a system of coloured trays for identifying individuals that needed assistance with feeding and whose diet had to be monitored. Comments from residents about the food provided included the following: • • • • • “The food is very good, we have cooked breakfast, then lunch and a cooked evening meal. We have drinks and biscuits or what you like between”. “The food is good. You can have as much as you want. You can ask for more if you want it. We have cooked breakfast. I have never known a place like it”. “The food is lovely, there is plenty and sometimes too much”. “The food is good. They come and ask us what we want the day before, what we want for breakfast and lunch. You can have cooked breakfast if you want and I do. “The food is excellent. I think we must all be putting on weight. They come around every day and ask what choice you want for the next day”. DS0000011476.V336127.R01.S.doc Version 5.2 Page 18 Bedhampton Nursing Home Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 19 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 excellent. This judgement has been made using available evidence including a visit to this service. The home has a clear and satisfactory complaints procedure to address any concerns raised by residents and relatives/representatives. Robust procedures are in place to protect service users from the risk of abuse. EVIDENCE: The home has a complaints policy that clearly states the process for service users or their relatives to raise any concerns about the home and care. This is documented in the Service User’s Guide. Service users spoken with and surveys returned to the CSCI indicated that they would speak to a member of staff or the manager if they were worried or concerned about any aspect of their care. The inspector viewed the complaints records, none had been recorded since the last inspection. The home had written procedures available appertaining to adult protection. These are intended to provide guidance and ensure as far as reasonably possible that the risk of residents suffering harm is prevented. Staff spoken to said that they received training about adult protection and abuse and what constitutes abuse. Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 20 As part of their contract of employment all staff working in the home have to read and sign a statement about the abuse of vulnerable adults. It required them to report any incidents they witnessed or suspected that they believed constituted abuse. The inspector observed that abuse awareness and training is contained in the skills for care induction programme. The home had written policies and procedures for the use of bed rails and mechanical restraints. The inspector observed that, where bedrails were in use there was documented evidence that a risk assessment had been undertaken and permission had been sought or discussion with relatives about their use, had been documented in care plans. Bedhampton Nursing Home DS0000011476.V336127.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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a safe, well maintained environment that is clean and hygienic. EVIDENCE: The inspector toured the home with the manager. The home was clean and in the process of having a ‘spring clean’. The inspector detected a slight offensive odour in one bedroom that was not being used at the time. The manager agreed and reported that she was investigating the source as she herself had detected this. The inspector observed that residents were able to bring personal items into the home including furniture and it was apparent from discussion with Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 22 residents and observation during a tour of the building that some individuals had taken trouble to personalise their bedroom accommodation. A number of residents had large collages of family pictures on the wall, which gave them opportunity to talk about their memories of that time. The service users spoken with and from the surveys returned by the service users and relatives indicated that they considered the home to be clean and well maintained and their environment to be pleasant. The inspector met the maintenance man who attends the home most days of the week to undertake repairs/decoration, keep the grounds and garden maintained, and ensure that safety systems were checked and serviced. The home was observed to be well maintained externally and internally and fixtures and fittings were of a good standard. The surrounding gardens are large and well maintained with occasional sitting areas around the grounds. A number of service users spoken with told the inspector that they love being in the garden in the fine weather. The home’s registered manager had attended a “train the trainer” course organised by the adult and older persons service of the local authority in “infection control” and there are comprehensive procedures and guidance including posters on display concerned with infection control. It was noted that in accordance with best practice all communal WCs that were seen were provided with liquid soap dispensers, alcohol gel sanitizers and paper towels. Protective clothing was readily available and staff were observed using gloves and aprons appropriately. The inspector observed that some personal toiletries were left in the bathrooms and the manager advised the inspector that these would be removed immediately to the appropriate bedrooms. The AQAA records state that all staff have undertaken infection control training and this was evidenced in the staff training files. The home’s laundry was appropriately sited and equipped and effective procedures were in place for the management of soiled laundry items. Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has the appropriate level and mix of staff on duty at any one time that ensures the needs of residents are met. The home has a robust staff recruitment procedure that ensures the service users are protected and supported by staff that are appropriately trained. EVIDENCE: The inspector viewed a sample of staff recruitment files. It was observed that all statutorily required pre-employment checks, intended to ensure that people unsuitable to work with vulnerable adults were not employed, had been completed before the individuals concerned actually started working in the home. All new staff received comprehensive induction programmes that were evidenced in the staff files. The home has employed a number of care staff in recent months that are undertaking the Skills for Care twelve-week induction programme. The inspector viewed a sample of these in training files. Some have been completed and some staff are in the process of completing the programme. Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 24 Staff spoken with confirmed that they were undertaking this and thought it to be comprehensive and enabled them to understand what good practice was. The AQQA documents records that over 50 of the care staff have achieved NVQ level 2 or above and a further two were in the process of completing this training. The AQQA also recorded that other sources of training has been obtained to develop staff knowledge and additional qualifications. Conversation with staff indicated that in addition to their induction training they have attended training in subjects that ensured that their clinical knowledge and skills are up to date. The staff told the inspector that their training needs are discussed at their yearly appraisal with the manager, or at supervision. The inspector viewed a sample of training files and these demonstrated that staff are encouraged to update their skills and frequent training is made available to all staff. Staff training files hold all the training records and the inspector suggested to the manager that a training matrix be created to enable her to identify more easily what staff have received what training and when. The staff rotas were viewed. The home can accommodate thirty (30) residents, and at the time of this site visit there were twenty five (25) in residence. The manager reports that staffing levels are not altered if there are fewer service users in residence. On an average morning two (2) trained nurses and six to seven (6-7) carers are on duty, One (1) trained and four (4) carers in the p.m. shift and one (1) trained and two (2) carers on at night. The manager told the inspector that she is not counted in the numbers of staff but is present in the home for five days a week. The organisation also employs a consultant nurse who is in the home Monday to Friday all day. Apart from registered nurses and health care assistants the home employs other ancillary staff and these comprise of: Administrator Chefs Kitchen assistants Cleaners Laundry assistant Maintenance personnel The atmosphere in the home was unhurried and on the morning of this visit there were seven carers on duty with two trained nurses. Staff spoken with said they felt well supported and that the staffing levels were ‘good’ and they felt they had time to spend with residents. The inspector observed throughout the day that staff were sitting and chatting to residents and there was always staff present in the lounge. Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 25 Service users spoken with and surveys returned to the CSCI from service users and relatives stated that there was always staff available. The inspector observed that when a call bell was sounded it was responded to quickly. The inspector concluded that the home could demonstrate that sufficient staff are on duty each day to meet the needs of the current residents. Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 26 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 home’s manager provides effective leadership The home has systems and procedures in place for monitoring and maintaining the quality of the service provided and promoting the safety and welfare of everyone living and working in the home. EVIDENCE: The registered manager had first been employed in the home as deputy manager in 1997 and has been in her current post approximately 5 years. She had been qualified as a registered nurse since 1984 and had specialised in elderly care and also has achieved the Registered Managers Award (RMA). Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 27 From discussion with staff, residents and relatives it was apparent that the registered manager is highly motivated and committed to the home and her role. The inspector observed that there were relaxed and friendly relationships between the manager and residents. Service users spoken with indicated that they felt a sense of confidence in the manager to ensure they were cared for. Examination of the home’s documentation and management systems indicated that she was organised, kept up to date with developments in health and social care and was committed to staff training and development. The home has systems in place for monitoring the quality of the service provided and includes the use of questionnaires to obtain the views of residents and relatives. The responses from these and details of any action that had been taken as a result is summarised in the home’s “Residents Guide”. Representatives of the organisation that own the home conduct monthly visits to the home in accordance with Regulation 26 of the Care Homes Regulations 2001. These visits are also used to monitor the quality of the service the home provides and the persons visiting complete audits of the home’s systems including; plans of care; staff training; and the environment. The manager was involved with the completion of the Annual Quality Assurance Assessment (AQAA) that was returned to the CSCI. This detailed the outcomes of the quality audit, which was undertaken by the provider, of all the standards and of the service as a whole, The report described how the organisation is striving to ensure that the services provided in the home are person centred and driven by the needs of the people who use the service and detailed plans for further improvements over the next twelve months. As part of the manager’s quality control resident’s meetings are held regularly and minutes from these meetings indicated that residents were able to influence day-to-day life in the home. The manager also audits care plans regularly, MAR sheets weekly and audits the environment monthly. There were a range of written policies and procedures available for staff to refer to as guidance and to inform their practice. The home does hold monies on behalf of some residents, which are held in individual containers in a safe environment. The inspector viewed a sample of the records of in coming and out going monies. These were recorded accurately with appropriate receipts kept. The balance of the monies is audited by the administrator at the time of any transactions. The home does not hold large amounts of monies. Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 28 Records examined indicated that the home’s equipment and systems are checked and serviced at appropriate intervals i.e. passenger lift and hoists; fire safety equipment, hot water system; etc. There were contracts in place for the disposal of clinical and household waste. Records are kept of all accidents in an appropriate format and adheres to the Date Protection Act. Staff said that they attended regular and compulsory fire and other health and safety training. Records of these were found in the training files. There are two staff employed in the home that are accredited moving and handling trainers and who deliver all the moving and handling training as necessary. The inspector observed that there were hoists, and other equipment in the home to promote safe working practices. The manager told the inspector that some of the hoists are about to be replaced with more up to date equipment. Fire training for staff was observed to be recorded in the fire log. The inspector viewed a fire risk assessment for the premises. On the tour of the building the inspector observed a cupboard door left unlocked in which all cleaning materials are stored. The manager reported that this was left unlocked whilst the housekeeping staff were working in the home. A recommendation will be made that this door is secured at all times when staff are not in attendance. Bedhampton Nursing Home DS0000011476.V336127.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 4 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP38 OP30 Good Practice Recommendations It is recommended that the cleaning cupboard door be kept locked at all times to prevent easy access to cleaning chemicals hazardous to health. It is recommended that a training matrix be produced to enable easy identification of training staff have completed and when. Also to ensure that all staff have received mandatory training within the previous year. Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Bedhampton Nursing Home DS0000011476.V336127.R01.S.doc Version 5.2 Page 32 - 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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