Inspection on 22/05/08 for Bemerton Lodge

This inspection was carried out on 22nd May 2008.

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

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

Other inspections for this house

Bemerton Lodge 06/06/06

Bemerton Lodge 22/11/05

Bemerton Lodge 24/05/05

Bemerton Lodge 10/02/05

Bemerton Lodge 23/08/04

Bemerton Lodge 26/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Bemerton Lodge Christie Miller Road Salisbury Wiltshire SP2 7EN Lead Inspector Alison Duffy Unannounced Inspection 22nd May 2008 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 Bemerton Lodge DS0000028264.V358971.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. Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bemerton Lodge Address Christie Miller Road Salisbury Wiltshire SP2 7EN 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) 01722 324085 01722 324561 manager.bemertonlodge@osjctwilts.co.uk www.oxfordshire.gov.uk The Orders Of St John Care Trust Mrs Teresa Elisabeth Baldwin Care Home 56 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (36) of places Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may, from time to time admit one person aged 60 - 65 years 6th June 2006 Date of last inspection Brief Description of the Service: Bemerton Lodge was built in the 1970’s. It is a residential care home, for up to 56 older people, 20 of whom may have a dementia. Originally managed by Wiltshire County Council, the home is now registered to the Orders of St John Care Trust. Mrs Teresa Baldwin is the registered manager although is shortly leaving for a new post. While recruiting for Mrs Baldwin’s replacement, Mrs Ruth O’Dea, currently head of care, is undertaking the role, as acting manager. Mrs O’Dea will receive support from senior managers of the Orders of St John Care Trust. Bemerton Lodge is situated within a residential area, on the outskirts of Salisbury city centre. There is car parking on site, and it is near a bus route. There are a variety of sitting and dining rooms. People’s bedrooms and communal areas are located on the ground and first floor. A passenger lift gives easy access to the first floor. Additional day centre facilities are located in an adjoining building. If the person is self-funding, the fees for living at the home are negotiable. They start at £430.00 for standard care needs, £465.00 for high dependency needs and £510.00 for very high dependency needs, a week. If a placing authority arranges the placement, the fees range between £407.85 and £533.38 a week. Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection took place over two days. The first day took place on the 22nd May 2008 between the hours of 9.45am and 5.30pm. Mrs Baldwin was on annual leave so Ms R O’Dea, head of care assisted, as required. The second day was arranged to meet with Mrs Baldwin. This took place on the 25th June 2008, between 11.30am and 6.45pm. Mrs Baldwin and Ms Mudie, a local manager within the organisation, received feedback. The pharmacy inspector visited to look at the medication systems. The findings of this visit are detailed within this report. We met with people, who use the service in their own rooms and within communal areas. We met with the staff members on duty. We looked at the management of peoples’ personal monies. We observed the serving of lunch and tea. We looked at care-planning information, training records, staffing rosters and recruitment documentation. As part of the inspection process, we sent surveys to the home for people to complete, if they wanted to. We also sent surveys, to be distributed by the home to peoples’ relatives, their GPs and other health care professionals. The feedback received, is reported upon within this report. We sent Mrs Baldwin an Annual Quality Assurance Assessment (AQAA) to complete. This was completed in detail and returned on time. Information from the AQAA is detailed within this report. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. What the service does well: People are offered a good level of social activity provision both in the home and within the wider community. Meal provision is of a good standard with an emphasis on fresh produce and an aim to enable people to fully enjoy all meals. Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 6 Staff are positive about their role and have built good relationships with people. People are encouraged to give their views about the service and staff seek to achieve any suggestions made. People are clear about the ways in which they can raise any concerns. Training is given priority and ranges of subjects, other than those, which are mandatory, have been arranged. Robust recruitment procedures are in place and a high level of health and safety material is available for staff reference. The home is well managed with clear leadership and a focus to achieve good outcomes for people. What has improved since the last inspection? What they could do better: Care planning generally reflected people’s needs. However, ways in which enablement and independence are promoted should be central within the care plans of those people, within the short stay unit. When asked to support people with tasks such as making a hot drink, there should be evidence of how this was performed, for monitoring of progress. In the event of a person requiring regular input from a district nurse, staff should maintain their own records and not rely solely on the district nursing notes. The care plan for medication must include information about any medicines prescribed ‘as required’ so that accurate and safe administration can take place. Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 7 A record must be kept of all medicines administered to people in the home, including those given by nurses, so that a complete record of their care is maintained. 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. Bemerton Lodge DS0000028264.V358971.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 Bemerton Lodge DS0000028264.V358971.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 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are encouraged to visit the home and are assessed before admission, enabling an appropriate placement. EVIDENCE: Within the AQAA, Mrs Baldwin stated ‘all residents receive a full needs led assessment prior to admission, this is conducted by a senior member of the team. Our assessment covers all aspects of the individuals life, gathering as much information as possible without appearing to be invasive.’ Mrs Baldwin told us about the importance she places on a detailed assessment process to ensure people’s needs can be met. We looked at the two written assessments of newly admitted people. These had been completed in detail. There was a tick style format yet additional information had been written to ensure clarity. The assessments were signed and dated and gave evidence of where they took place. Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 10 People told us they were able to look around the home before making their decision to move in. Some people were aware of Bemerton Lodge due to living within the local vicinity. One person had attended the adjoining day centre. Others said they had left the decision of choosing the home, to their family. Within surveys, people told us they had suficient information about the home, before moving in. One relative said ‘we feel grateful that our XX is so settled in this, our choice of care home.’ Bemerton Lodge has recently allocated ten bedrooms for intermediate care. The places are contracted to a local authority. The local authority manages the referral process in consultation with Mrs Baldwin. A copy of the assessment is always received before a placement is offered. The home also completes their own written assessment. Mrs Baldwin said she has spoken to her line manager about reducing the content of the existing documentation for the intermediate care unit. We agreed that a more targeted approach, emphasising enablement and independence would be beneficial. Mrs Baldwin told us the intermediate care service is in its early stages and therefore evolving. We talked to a health care professional who is involved in the unit, on a daily basis. They confirmed the service is developing yet working well. They said people had returned home successfully. Bemerton Lodge DS0000028264.V358971.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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans generally reflect people’s needs. However, greater clarity of enablement and promoting independence would benefit those in the intermediate care unit. Medication handling is carried out in a safe manner, however more medication care plans would help staff to administer ‘as required’ medication more effectively. People’s rights to privacy and dignity are maintained. EVIDENCE: People told us that they were very happy with the care they received. One person said ‘the girls are lovely, they help me have a wash every morning.’ Another said ‘they pop in to see if I need any help.’ One person told us they could have a bath when they asked for one. Within surveys, relatives told us they were happy with the care given to their relative. One relative said ‘the levels of care agreed is always met and this is respectful of what my XX is able to do/or not on a daily basis i.e. if she feels Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 12 able to dress and wants to herself she can, consequently if she needs help, it is offered.’ Another relative told us ‘residents are looked after with the up most care.’ We looked at a sample of care plans. All had recently been developed due to the introduction of a new care planning system. The care plans contained detail of the support people needed and their preferred daily routines. There was good detail about mobility, washing and dressing and any equipment people needed. Specific instructions to staff such as ensuring a person had appropriate footwear, were identified. Procedures to follow in the event of an infection were clear. One care plan contained a range of information about the management of diabetes. The information was located in different parts of the file. We advised that a specific diabetes care plan should be developed. Each person had a manual handling, tissue viability and nutritional assessment in place. There were details of control measures to minimise any risk identified. We saw that a district nurse was regularly visiting one person. Information within the care plan about the reason for the intervention was not clear. There was no evidence of the healing process. We advised that staff should maintain their own documentation and not rely on the district nursing notes. We looked at the care plan of one of the people using the short stay unit. The plan did not clearly state the support the person needed to promote their independence. We saw that the occupational therapist had asked for staff to support the person to make hot drink on a regular basis. There was no evidence of this within the care plan or the daily records. Mrs Baldwin told us that she had identified the existing care plan format was not conducive for the needs of the people within the short stay unit. Mrs Baldwin said she had raised the need for a more simplified document, with senior managers of the organisation. We said that the approaches staff needed to follow in terms of enablement should be identified within the care plan. Daily records should also evidence the support the person needed to complete any particular tasks. We spoke to a physiotherapist who worked with people in the short stay unit. They told us the service was developing yet working well. They said they would appreciate staff recording greater detail within documentation, as this would enable them to make clearer assessments on the person’s progress. Each person had a record detailing any healthcare intervention. This included the GP, district nurse, chiropodist and optician. A regular record of people’s weight was maintained. Any marks or bruises noted on a person were recorded on body maps in the care plan. We advised staff record specific details of the area, such as the size and colour, for monitoring purposes. We saw that the chiropodist had noticed a sore on the person’s heal. This was not identified in the person’s care plan. Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 13 People told us that they could ask for their GP at any time. One person said ‘staff are very good at noticing when you are not very well.’ Another person told us how staff had looked after them when they were poorly. Within surveys people told us they received the medical support they needed. One relative told us ‘good support with hospital and dentist appointments.’ Another said ‘my XX has dementia, they seem to understand this loss of memory quite well.’ A health care professional expressed a positive view about the home, within their survey. They said ‘I have always been impressed by Bemerton Lodge. They make timely contact with the CMHT [Community Mental Health Team] if residents’ needs increase and act on advice given.’ Our Pharmacist Inspector looked at arrangements for the handling of medicines. A new medicine room had been established. This enabled staff to store and organise the medicines more safely and conveniently. Records of administration were clear. This included those medicines prescribed ‘as required’. People in the home were able to look after their own medicines if they wanted to. Staff supported them to do so. This was particularly apparent in the short stay unit. District nurses gave some medication by injection. Although staff are not involved in this process, a record of the doses and times of administration, should be kept in the home for reference. Plans for the care of people with particular medical conditions showed an understanding of their circumstances. However there were two, which lacked important information. These related to the use of medicines prescribed, ‘as required’. There was no record of the indication for the use of the medication or the period required between doses. Some medicine prescribed in this way was being given regularly. These people should have their medication reviewed by the doctor and the prescription changed if necessary. Staff were knowledgeable about the medicines they were using. They showed us a new E-learning program for medication handling, which they were completing. People told us their privacy and dignity were maintained. They said staff were friendly, respectful and treated them well. We saw that staff knocked on people’s doors and waited to be asked in, before entering. Personal care was undertaken in private. People said they could spend time in their room and not be disturbed. People’s preferences of receiving their intimate personal care, from a female member of staff was identified on their care plan. Within surveys, a relative commented ‘Bemerton Lodge staff are totally respectful of all residents’ individual needs and are tolerant of all.’ Another relative said, in response to what the home does well, ‘the dignity and respect they give to residents.’ A health care professional said ‘the staff are excellent at respecting the residents’ privacy and dignity.’ Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 14 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are offered social activity provision both inside the home and within the wider community. People are able to follow their preferred routines and receive visitors as they wish. Meal provision is of a good standard and closely linked to peoples’ preferences. EVIDENCE: There is an activities coordinator who works 20 hours a week. They spoke of their role in detail and with enthusiasm. They said a weekly activity plan is developed. This is flexible and changed according to people’s wishes. The activity plan and photographs of events are displayed around the home. The activity coordinator said others, within the staff team, support them. This enables group and individual work with people, to be undertaken. They said they felt it important to maintain links with the community. Regular trips out are therefore arranged. People are able to attend the integral day centre, if they wish. There are regular residents meetings to enable people to share their views about the home. In response to a suggestion within a meeting, the activities room has been changed into a pub. New furniture and a flat screen television have been purchased to enable a social atmosphere. Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 15 A number of people, told us about the activities organiser. They said they could join in with activities or follow their personal interests in their room. One person said they enjoyed the quizzes. Another said they liked the sing-a-longs and skittles. We saw that staff spent time with people, talking about their families or items in the news. One person spoke of the hairdresser. They said the hairdressing room had been refurbished. Within surveys, people spoke positively about activities although some relatives commented that more provision would be beneficial. Comments included ‘more staff so that more time can be spent sitting for a little while and interacting with residents,’ ‘I would like to see the residents being entertained more, particularly at weekends’ and ‘I don’t know about the others but they look so bored sat round. It’s nice when something happens and they are all having a sing along but have only seen this once.’ Another relative, in response to the question what the home does well said ‘the way they try to develop self-confidence through activities (well organised and variety.)’ Another relative said ‘they listen to clients and relatives and have fun with all. There is lots of smiles and laughter. There are sales and garden parties – terrific, despite such hard work.’ People told us that they could have visitors at any time. They could entertain in their own room or in the communal areas. Staff told us that the ‘pub’ had been developed, in order to further encourage social interaction. They said they were aiming to develop ‘pub food’ during the evening for people and their relatives. Within surveys, the majority of relatives told us they were kept informed of events, affecting their relative. One person said ‘telephone communication is first class.’ Another said ‘on any occasion that my XX has needed a doctor or other facility someone has always contacted one of the family, which is good.’ People told us they were able to follow their preferred routines such as getting up and going to bed. People said they could eat where they wanted to and spend time, independently in their room. Within a survey, a relative told us ‘my XX has been encouraged to live the life s/he wants entirely due to the support and care of Bemerton Lodge. This is a major achievement.’ One member of staff told us ‘this is their home so we try to enable people to do what they want with their lives.’ The chef spoke with enthusiasm about the meal arrangements within the home. They told us that all meals are cooked from fresh ingredients. There is an emphasis on fresh fruit and vegetables and good quality, fresh meat. Homemade cake is readily available. There is a rolling menu yet this is flexible according to people’s wishes and the availability of produce. The chef told us that people can ask for what they want, as long as their request arrives in the kitchen before 11am. The chef told us that one person particularly likes mixed Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 16 grill. The items required for this are ordered from the butcher, the day before the person wishes to have it. The lunchtime meal looked appetising and was served according to individual wishes. At the last inspection a requirement was made to ensure adequate staffing levels at mealtimes. Mrs Baldwin told us that extra care hours had been gained. We saw that the staffing levels, at this inspection, enabled people an efficient yet relaxed service throughout their meal. People gave very positive feedback about the food. Specific comments included ‘the food is excellent, there’s a choice and it is always nicely cooked and lovely and hot.’ Another person said ‘we can’t complain at all about the food, there’s lots of it and it’s well cooked.’ Within surveys, one relative told us ‘the choice of food and quality is very good.’ Other comments were ‘wonderful menu – meals excellent’ and ‘the food seems to be of the highest quality.’ Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 17 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are encouraged to give their views about the service and are clear about the ways in which they can raise concerns. People are assured greater protection through well-managed adult protection systems. EVIDENCE: People told us they would tell the manager or a member of staff if they were unhappy. One person said ‘I would go down to the office to sort it out.’ Mrs Baldwin told us that she encourages an open approach, when raising concerns. She said any issues are addressed at an early stage if possible, through informal discussion. The home’s complaint’s procedure is displayed in the hallway. A record of formal complaints is maintained. The record contains details of any investigations, the outcomes and the response to the complainant. We advised a record be kept of concerns, which are readily addressed on a day to day basis. Within surveys, people told us that they knew how to make a complaint. One relative said ‘I have to be my XX’s voice and if I have any concerns I take them to the manager/deputy and they are resolved.’ Another said ‘if I have a problem I will ask for a meeting and things are resolved.’ Further comments included [the complaint procedure is] ‘on the board – very clearly seen on Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 18 entering building’ and ‘I have the information on file.’ Two relatives told us that any concerns are always met and dealt with promptly and efficiently. During the inspection, we asked a member of staff, a hypothetical question about abuse. They said they would immediately inform a care leader who would then inform the manager. In the absence of the manager, staff said they had contact details of senior managers. Staff were aware of the local adult protection reporting procedures, ‘No Secrets in Wiltshire and Swindon.’ Mrs Baldwin told us that all staff had been given a copy of the procedure. Staffing records demonstrated that staff had received up to date adult protection training. Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 19 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Significant focus has been given to improving the environment for people. All areas were clean, comfortable and well maintained. EVIDENCE: People’s bedrooms are located on the ground and first floor. People said they could personalise their rooms, as they wished. Many had their own furniture. All had an accessible call bell. People said that staff came to them quickly when they called for assistance. Since the last inspection, all except one of the carpets in the corridors, had been replaced. These areas had also been redecorated. Mrs O’Dea said the last remaining old carpet in the corridors was being replaced. The hairdressing room had been totally refurbished enabling people to have a comfortable environment to socialise, while having their hair done. The old art room had been changed to a ‘pub.’ New furniture and a flat screen television had been Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 20 purchased. There was a bar, a dartboard and a games console within the room. The area was pleasant, light and inviting. We saw that the upstairs dining room had been refurbished. A partition wall had been knocked down to give greater space. Four small lounges had also been redecorated. Two had new furniture. People chose the colour scheme of the carpets and curtains. Mrs O’Dea told us a bathroom and sluice had been refurbished. She said there were plans to refurbish a further bathroom. There was also an ongoing programme to redecorate and replace carpets and furnishings in peoples’ bedrooms. The recommendation, made at the last inspection, to remove a rusty toilet frame had been addressed. At the last inspection a requirement was made to complete a survey of all external windows, leading to a programme of servicing those, where risks were identified. Mrs Baldwin told us that a representative from the organisation’s property maintenance department had done this. A number of windows had been adjusted to ensure they opened effectively yet safely. All areas were cleaned to a good standard. There were no unpleasant odours. Hand washbasins contained pump action soap dispensers and paper towels to minimise the risk of infection. Staff had access to protective clothing, as required. Within surveys, relatives said ‘the surroundings are very homely and they always make relatives/people feel welcome’ and ‘always very clean everywhere – the housekeepers are much in evidence – no horrid odours and that must be difficult.’ Mrs Baldwin told us a new post of head housekeeper had been developed. The person in post would supervise the housekeepers and ensure the standard of cleanliness was maintained. Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 21 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a staff team who well trained, motivated and committed to providing a good standard of care. People are protected through a clear, wellmanaged recruitment procedure. EVIDENCE: There are generally six or seven carers and a care leader on duty, during the waking day. At night there are three or four waking night staff. Mrs Baldwin told us that she is currently recruiting night staff. When successfully in post, Mrs Baldwin is aiming to have four staff on duty each night. During the day, in addition to the care staff team, there are housekeeping and catering staff, an administrator, an activities coordinator, a seamstress and a maintenance person. People were very complimentary about the staff. One person said ‘they will do anything you ask them.’ Another person said ‘they are always bright and friendly. You’d be able to talk to them if you had a problem.’ Within surveys, there were various comments about staff. These included ‘staff are always kind and caring towards him/her,’ ‘the staff have excellent care skills to meet a wide and variety of needs’ and ‘most staff present in a kind, professional approach. I am aware that NVQ’s are ongoing and care leaders display a sharing of appropriate knowledge and care.’ One relative said ‘this is Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 22 the first encounter I have had with a care home and have the dearest admiration for the carers and their dedication to their work.’ Mrs Baldwin told us that 66 of the care staff had NVQ level 2 or above. Two staff were working towards the award. All housekeepers had an NVQ qualification. We saw from the training records that staff are kept up to date with their mandatory training. Other topics are also covered. There was evidence that staff had had training in infection control, dementia, safe handling of medication and adult protection. Mrs Baldwin told us, specialist personnel including the Parkinson’s Nurse and a representative from Age Concern and the Falls Clinic had facilitated training sessions. Training in care of the dying, foot care and the management of diabetes had been arranged and would be completed next. Within their surveys, all staff told us they received training relevant to their role. Specific comments included ‘if we ever find a training course we feel we would find beneficial she [the manager] always does her best to oblige’ and ‘my home manager puts me on training when needed and if it is relevant to my job role. This helps me keep updated and I can carry out my role as a carer more competently.’ Staff confirmed that training is given high priority. They gave lengthy descriptions of the training they had undertaken. One member of staff said ‘training, there’s ‘loads’ of it. We get to do all sorts here.’ Within a survey, a relative told us ‘it does seem staff have dementia training which is good. Another aspect is the staff turnover is fairly low, therefore staff get to know residents and vice versa.’ We looked at the recruitment documentation of three most recently employed members of staff. All files contained the required information. All prospective staff had been checked against the Protection of Vulnerable Adults register before commencing employment. This assured their suitability to work with vulnerable people. Documentation confirmed that staff had been given a copy of the ‘No Secrets’ pamphlet and the General Social Care Code of Conduct, when they commenced employment. Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 23 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 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a well managed home with clear leadership. Systems are in place to regularly audit and improve the service given to people. The safe keeping of peoples’ personal monies is well managed therefore minimising the risk of financial abuse. Peoples’ wellbeing is promoted through clear health and safety systems. EVIDENCE: Mrs Baldwin has been the manager of the home for approximately two years. During this time she has been committed to developing service provision. Mrs Baldwin told us she aims to promote an open, supportive environment, whereby people feel able to express their views. People confirmed that they would go to her office if they had a problem. We saw this take place. Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 24 Within surveys there were positive comments about the management of the home. One relative said ‘I have to say that I feel Theresa [manager] and Ruth, her deputy, make my job as XX’s representative very much easier. If I had a concern, their door is open. They are always positive and strive to get issues resolved.’ Another relative told us ‘Theresa and Ruth display good leadership qualities.’ A member of staff said, in their survey, ‘my manageress has been fantastic and a wonderful support. She is always ready to listen to staff members and residents.’ Other comments were ‘manager is very supportive and encouraging. Her door is always open with any concerns’ and ‘we have an excellent non judgemental, fair minded manager whom all staff have the highest respect for.’ Ms Mudie had informed us under regulation 37, that Mrs Baldwin had gained alternative employment and was leaving the organisation. Mrs Baldwin explained her new position and confirmed she had one week left, before leaving. We saw some relatives thank Mrs Baldwin for her work at the home. Mrs Baldwin explained that Mrs O’Dea had been appointed acting manager until successful recruitment took place. Mrs Baldwin and Mrs O’Dea have been working together to ensure a smooth transition. The home has a quality assurance system that is used within all of the homes within the organisation. The system consists of various audits and questionnaires. The questionnaires are sent out to people who use the service on an annual basis. The findings were discussed in a residents’ meeting and displayed on a notice board. The most recent audit showed four noncompliances. Mrs Baldwin told us these were immediately addressed. A number of people have placed amounts of their personal monies, for the home to hold safely. We looked at the systems for managing this. We recommended that some amounts of monies stored were monitored and kept to a minimum. Cash amounts corresponded with the balance sheets. Two members of staff had signed all transactions and receipts were in place. The administrator and Ms Baldwin had regularly audited the systems. The administrator told us, representatives from the organisation also complete regular audits. The organisation has a range of health and safety policies and procedures. Regular health and safety audits take place. Systems are in place to monitor issues such as hot water temperatures. Radiators have been covered to reduce the risk of scalding. There were a range of environmental risk assessments. Some individual risk assessments were located on people’s care plans. Equipment such as manual hoists and the fire alarm systems were serviced regularly, as part of a contract. The organisation has specific contractors, which the home must use. Staff are up to date with their mandatory training such as first aid. One member of staff is a manual-handling trainer. Another staff member is currently undertaking the course. This enables manual handling training to be provided on a regular basis, as required. Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 25 We saw from the AQAA, that Mrs Baldwin has maintained a link with the Health Protection Agency, regularly attending meetings with other providers to keep abreast of new developments. Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 26 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 3 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 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 3 X 3 X X 3 Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The registered person must ensure that care plans for the people within the short stay unit, clearly reflect the need to promote independence. The care plan for medication must include information about any medicines prescribed ‘as required’ so that accurate and safe administration can take place. A record must be kept of all medicines administered to people in the home, including those given by nurses, so that a complete record of their care is maintained. Timescale for action 31/08/08 2 OP9 Reg 17(1)(a) sched 3(m) Reg 17(1)(a) sched 3(i) 31/08/08 3 OP9 25/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP6 Good Practice Recommendations The registered person should ensure that the assessment DS0000028264.V358971.R01.S.doc Version 5.2 Page 28 Bemerton Lodge 2 3 4 OP7 OP7 OP16 and care planning formats are more conducive to the needs of people within the short stay unit. The registered person should ensure that tasks that staff support people to do, such as making a hot drink within the short stay unit, are clearly evidenced. The registered person should ensure that the management of a person’s diabetes is addressed within one area of the care plan. The registered person should ensure a record of any concerns, which are dealt with on a daily basis, is maintained. Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bemerton Lodge DS0000028264.V358971.R01.S.doc Version 5.2 Page 30 - 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. 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