Inspection on 06/06/06 for Bemerton Lodge

This inspection was carried out on 6th June 2006.

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

The inspector 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 22/05/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bemerton Lodge Christie Miller Road Salisbury Wiltshire SP2 7EN Lead Inspector Roy Gregory Key Inspection 6th June 2006 9:40 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.V296074.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.V296074.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 The Orders Of St John Care Trust Mrs Teresa 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.V296074.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd November 2005 Brief Description of the Service: Bemerton Lodge is a purpose-built home for up to 56 Older People, 20 places being registered for people who have dementia. The home is one of a number in Wiltshire, Gloucestershire, Oxfordshire and Lincolnshire owned and managed by the Orders of St John Care Trust. The home was built in the 1970s and there are intentions to redevelop the site with a modern replacement. Nevertheless, the home has received refurbishments in a number of areas during the past three years, including redecoration of each bedroom. The accommodation is arranged over two floors, connected by passenger lift, and spread over six wings. There are a variety of sitting and dining rooms. Additional day centre facilities are located in an adjoining building. Bemerton Lodge is located in attractive grounds in a residential area, north of Salisbury city centre. There is car parking on site, and it is near a bus route. Weekly fee levels range between £390 - £460, dependant on assessed dependency. Bemerton Lodge DS0000028264.V296074.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced visit for this inspection was made on Tuesday 6th June 2006 from 9:40 a.m., with a return visit on Wednesday 7th June at 9:25 a.m. Also visiting on 6th June was the pharmacist inspector. The registered manager, Mrs Baldwin, was available on the second day, whilst the inspector also spoke with two care leaders, the activities co-ordinator, the administrator, and members of the care and support staff teams. During the inspection there were conversations with two visiting district nurses, a psychiatric social worker and with people visiting their relatives. A number of residents were spoken with, including sharing a lunch at table with four of them and attending part of a residents’ meeting. The entire home was toured, with some individual rooms being seen. Prior to the inspection, pre-inspection information had been received from Mrs Baldwin. Additionally, seven survey forms have been received from residents, and there was a response to request for observations from the local social work team (Department of Adult and Community Services). During the inspection, documentation looked at included records in respect of care planning and delivery, complaints, training and recruitment, risk assessments and fire precautions records. The pharmacist inspector examined medication storage and records in detail. A number of instances of care giving were observed, and the inspector sat in on a staff shift handover. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. What the service does well: The survey forms returned by a cross section of residents and relatives contained no negative responses and indicated high levels of satisfaction. Added comments included: “Bemerton Lodge is an excellent home. The atmosphere is caring and friendly. The residents are happy and well cared for” and “The staff here are very kind and look after me very well”. A summary of feedback from care managers from the Adult and Community team said first that “staff are helpful and the manager is very willing to discuss any issues care managers or service users have and to take action on them.” Also “There are a number of activities offered to residents, which is a very positive aspect.” These comments were reflected in the views of residents and visitors during the inspection visit. The engagement of residents in a variety of activities, both planned and spontaneous, was evident, and several spoke with enthusiasm of things they had done or were going to do. This was a credit not only to the hard work and enthusiasm of the activities co-ordinator, but also to a care planning system that engenders individual plans, keeps them under review and Bemerton Lodge DS0000028264.V296074.R01.S.doc Version 5.2 Page 6 recognises a range of “whole person” needs. Residents and relatives were always complimentary of the way in which staff of all grades worked with them. Recently admitted residents and their relatives appreciated the handling of the assessment and admission processes. Information gained at that stage led into individual care plans and risk assessments, in which there was evidence of resident participation. Visiting district nurses and a psychiatric social worker were complimentary of their working relationships with the home. Care records showed prompt referrals of health concerns to GPs, specialist nurses and other professionals, along with co-operation with treatment plans. A resident wrote on a survey form “any health problems are well attended and receive a quick response.” What has improved since the last inspection? What they could do better: Bemerton Lodge is an ageing building and so some parts are not of a modern standard. Individual bedrooms can be small, making incorporation of one’s own belongings difficult. One resident spoke of a lack of soundproofing. These kinds of shortfalls are not amenable to change. However, it was identified that many windows present difficulty in operation, which can be rectified by survey and servicing as appropriate. The sluice rooms are out-dated and need to be brought up to a modern standard, as they pose cross infection risks as they are. Similarly, in many toilets and bathrooms there were indications of risk being posed by rusting fittings, poor paintwork etc., which could be picked up by a regular internal audit, say by the handyman, and made good more systematically. It is recommended the handyman be included in infection control training, because aspects of his work overlap with the work of the housekeepers. Aside from environmental concerns, there is a requirement to improve the availability of staff to residents. In response to the question “are the staff available when you need them?” four out of seven survey respondents answered “usually” rather than “always”. After lunch and through the shift handover period, actual staff on the ground were few and far between, Bemerton Lodge DS0000028264.V296074.R01.S.doc Version 5.2 Page 7 resulting in risk to vulnerable residents. The manager had already identified such problems and begun to address them. 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. Bemerton Lodge DS0000028264.V296074.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.V296074.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5 (Key Standard 6 does not apply to Bemerton Lodge) Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are only admitted to the home on the basis of a professional assessment that demonstrates their needs can be met. EVIDENCE: Records and residents’ accounts confirmed that all admissions were preceded by an assessment by the manager or a care leader to determine the home could meet the individuals’ needs. For those residents whose places were arranged by Adult Care or Mental Health services, the appropriate professional assessments were also in place. The home’s assessment makes use of two dependency tools, and the long-term needs component of the care planning system, which assists drawing up the initial short-term care plans. Where a resident is to be re-admitted from hospital, a re-assessment is carried out to ensure the home can again meet the person’s needs. A resident had been recently returned unannounced to the home without such re-assessment having been possible, and this had led immediately to difficulties. Mrs Baldwin Bemerton Lodge DS0000028264.V296074.R01.S.doc Version 5.2 Page 10 had been active in obtaining medical backing to her insistence that the placement was inappropriate for the individual concerned, who had then transferred back to hospital. A further difficulty encountered by the home, as described by a recently admitted resident, was that following the home’s assessment that a hospital patient’s needs could be met in residential care, no time was allowed by the hospital for arrangement of a visit to the home by the individual, prior to discharge from the hospital. This undermined the preferred practice of the home, that all prospective residents should have such an opportunity, and should be involved in the choice to move there, however circumscribed such choice may be in reality. It is recommended that where possible, a visit to the home should form part of the assessment, before a decision is reached on whether the home can meet an individual’s needs. A permanent resident’s stay at the home is confirmed after an initial four-week period, after which contracts are put in place. A respondent to the survey of residents commented on “an excellent introduction to the home”. Since the previous inspection, Bemerton Lodge has ceased provision of intermediate care; hence key standard 6 no longer applies. Bemerton Lodge DS0000028264.V296074.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 - 10 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Individual care plans receive regular review and direct care across a spectrum of need. There is prompt awareness of and response to health needs, including excellent liaison with health professionals and emergency services. Systems and practice in handling medications are mainly good, subject to better recording of the use of “as needed” medicines. The approach to the care task is based on respect for diversity and privacy. EVIDENCE: A resident identified clear improvements in his wellbeing since admission to the home. He described assistance to diet and monitoring his weight, and felt his health care was a shared effort between himself and staff. Two district nurses attending the home at the time of the inspection visit said they found no difficulties in liaising with the home. Whilst they might like more assistance to having their patients ready to see them, they appreciated that residents are “at home” and free to be where they wish at any time. In any case, there had been discussion about the issue, and there was a commitment Bemerton Lodge DS0000028264.V296074.R01.S.doc Version 5.2 Page 12 by the home to create a “clinic” room from what is presently the hairdressing room, for which residents could be given appointments, if they wish, as an alternative to receiving treatments in their own rooms. The nurses said care staff swiftly referred any pressure area concerns for their attention, and complied fully with their treatment plans. They saw no evidence of poor nutrition. A visiting mental health social worker also spoke of satisfactory liaison with Bemerton Lodge. She considered the home made appropriate demands of the mental health services, finding the necessary balance between the needs of individuals and of the service user group as a whole. She commented on the excellent support a resident was receiving from their key worker, and the inspector saw other examples of such positive working relationships. Mrs Baldwin intended delegating a carer to the task of liaison with district nurses, to enhance the developing relationship. Care plans reflected “whole person” needs. For example, for a person with Parkinson’s disease, there was a good picture of what this meant in practice for the individual, including evidence of liaison with a specialist nurse; and there was also a plan for activities known to be enjoyed and preferred by the person, and guidance on working with their communication difficulties. The plan for pressure area care included a current risk assessment score, and stressed measures that would help prevent pressure damage occurring. For other residents whose records were examined, there was also a pressure area care plan related to their individually assessed risk, and an activity care plan that recognised the benefits of certain activities for the person. All care plans seen showed evidence of regular review and amendment, a process that would be further improved by combining or removing elements of a care plan when identified; for one person there was a short-term plan for assisting their orientation in the home following admission, which is good practice, but after initial evaluation that showed its effectiveness, it had continued to be reviewed as “no change”. Long-term needs assessments were detailed and appeared to reflect their subjects accurately, with evidence of amendments in response to identified changes. The home has a practice of keeping a care record every day for every resident, which staff found to be beneficial. It was easy to track the progression of matters from entries in daily notes to referrals to e.g. GPs, to entries in multidisciplinary notes and to changes to care plans. A respondent to the survey of residents wrote: “any health problems are well attended and receive a quick response”. In addition to the usual provision of hot drinks, plentiful cold drinks were on offer to residents, on what was a hot day. A care leader said GPs might ask that fluid intake be encouraged for certain individuals, in which case charts would be used. Care plans were in place to guide use of ‘as required’ medications, for example that an individual should be asked at medicine rounds whether they wished to Bemerton Lodge DS0000028264.V296074.R01.S.doc Version 5.2 Page 13 receive pain relief. Weights were now being consistently recorded, as required at the previous inspection. Medication use in the home was assessed by the pharmacist inspector, who reports as follows: Medicines are stored securely, however the accommodation is cramped and there is no clinic room where the ordering and checking of medication can be done without interruption. All staff who administer medication have internal competency-based training and are able to refer to a comprehensive policy. (The lead inspector confirmed seven staff were currently undertaking a distance course in the safe administration of medicines). Appropriate records are maintained of medicine receipt and disposal. Records for the administration of medicines ‘as required’ are not always clear. The medicines are often recorded as being regularly offered and refused which is not the case. Doses (of ‘as required’ medicines) should only be recorded when they are given, with the time of administration clearly stated. Controlled drugs are correctly stored and recorded. Residents and a visitor commented on a consistent and respectful approach by staff in respect of residents’ needs and desires for privacy and exercising choice. The inspector observed care to be given with sensitivity and respect. Care plans also emphasised this aspect of caring, for example how to support independence and choice for someone with an ongoing risk of falling. All staff spoken to were aware of this person’s needs and risks and could be seen acting accordingly around them. The risk assessments in place showed they were founded on negotiation with the resident concerned. Bemerton Lodge DS0000028264.V296074.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 - 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home has developed regular activities provision that links with residents’ individual interests and capabilities, including provision for religious observance. Within daily life, residents are able to exercise many choices. Community and family contacts are encouraged. Meals are of good quality but could be enhanced by more attentive service. EVIDENCE: There was positive feedback from very many residents about the availability of activities within the home, and the dynamism of the activities co-ordinator in keeping up the momentum of activities, including one-to-one engagement. During the first morning of the inspection visit, many residents responded to encouragement to go out into the gardens. One was assisted with a watering task that had been pre-planned with them. Other residents attended a regular communion service held in one of the sitting rooms. The inspector saw residents confirming with the co-ordinator the arrangements for a forthcoming quiz. Generally, residents seemed to know what was available to them, and there was much talk about past and prospective activities. For example, two gentlemen talked of a trip they had joined to a model rail exhibition in Bemerton Lodge DS0000028264.V296074.R01.S.doc Version 5.2 Page 15 response to identified interests. A monthly newsletter was of good quality and set out forthcoming events. In June, these included church services, library visits, trips to a market and a garden, a concert in the home and a skittles competition. These were also publicised on notice boards, which were kept up to date and uncluttered. A board in the entrance foyer helped keep visitors up to date. A visitor had shared with the activities co-ordinator that their relative had complained of a lack of company, and had seen efforts made in response to meet their relative’s stimulation needs, including going on trips. The activities co-ordinator kept records of activities held and the degree of participation. It was evident she was very in touch with individuals’ preferences and she was continually modifying and innovating in response. There was much evidence of work in progress on forward planning. The inspector had the benefit of joining part of a residents’ meeting, in which there was lively discussion about ways of increasing opportunities for social mixing between residents of different parts of the home, and of activities generally. The manager spoke of plans by the Trust to introduce a computer for residents’ use to enhance leisure options and ways of keeping in touch with others. Care plans for activity needs recognised individual pleasures, such as listening to music, and simple occupational needs like clearing cups, as well as the more obvious “activities”. It would be a major task for the activities co-ordinator to review all activity care plans to see how far these identified and preferred needs have been met, whereas key worker involvement in this task, perhaps in tandem with their supervision, would enhance the “whole person” perspective and help ensure care planning remains focussed on quality of life. The inspector joined four residents for lunch. There was a choice of hot and cold meals and a choice of drinks. Service was polite and efficient, but for a long period the dining room was unattended by any staff, which left one resident to their own devices in trying to cut and butter a bread roll. Each dining room provided a pleasant ambience for eating and conversation, but the experience might be improved by staff enquiring that all is well, and offering second helpings if available. It was clear that satisfaction with meals was constantly monitored by obtaining feedback comments from different groups of residents. These included consideration of breakfasts and teas as well as lunches. The records suggested there was general contentment with meals, with little overt praise. They showed also that findings were shared directly with the chef. As an approach to resident-centred menus, Mrs Baldwin had distributed blank menu sheets to residents, for them to think of how they might like them planned, and this was an item for discussion at the residents’ meeting. A resident told the inspector changes had been made to the cooked breakfasts following a request by him at a residents’ meeting. A recently admitted resident was impressed by meals so far, particularly diabetic sweet options. Feedback from local social work staff was that many residents had praised the home’s afternoon teas. Bemerton Lodge DS0000028264.V296074.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. There is good provision for receipt of and response to complaints. Staff and management understand and exercise responsibilities in respect of keeping residents safe. EVIDENCE: Records showed a low level of complaints, at approximately one per month. One was a concern about staff attitude, which the manager was looking into even though the resident concerned did not wish it pursued as a complaint. There was very good recording of how complaints were presented and investigated, based on understanding the resident’s perspective. For example, a complaint of a smell of smoke had not been confirmed by anyone, but the handyman was detailed to check every possible source of smoke in and outside the resident’s room, so that reassurance could be given. There have been a few issues of behaviour incompatibility between residents. These have been appropriately referred to mental health services, and interagency “vulnerable adults” procedures if necessary, to enable objective agreed responses. Possible physical causes of changes in affect were always considered, and family members kept informed and involved. Examples were seen of additions to care plans to reflect agreed ways of managing potential difficulties. Information about a local advocacy service was available on all notice boards in the home. Mrs Baldwin has confirmed since the inspection visit that she has ordered the latest version of the abbreviated guidance to Bemerton Lodge DS0000028264.V296074.R01.S.doc Version 5.2 Page 17 vulnerable adult procedures, which is distributed to all staff as part of induction. A recent concern about intruders in the grounds had been reported to the police. Security of the site was well provided for and monitored as a health and safety matter. There was good information for visitors about the nature and necessity of security arrangements at the front entrance. Bemerton Lodge DS0000028264.V296074.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The environment provides for comfort, choice and safety, and is well maintained. Bedrooms may be individualised, but many are small and bland. Some windows present risks to service users. There are good standards of hygiene around the home, but some areas present a risk of cross infection, sluice rooms in particular. EVIDENCE: One part of the home has suffered greatly in the past from excessive temperatures in the summer, owing to a glass roof. At the previous inspection, work was underway to install a ceiling, and this was now complete. Staff were unsure how far this had ameliorated the temperature problem and were still monitoring, as well as using floor-standing fans. However, the inspector found an equable temperature on what was a very hot day, and the absence of glare from above was itself a notable improvement. One resident commented that the area was cool to come into, whilst another put on a cardigan. The overall Bemerton Lodge DS0000028264.V296074.R01.S.doc Version 5.2 Page 19 effect of installing the ceiling was to create a much more homely, intimate environment. A radiator had not been covered in line with previous requirement, but Mrs Baldwin arranged for this work to be undertaken immediately, rather than wait further for the order for the work to be fulfilled. A previously dark toilet had been provided with modern lighting. The home once again had a handyman, resulting in prompt responses to maintenance matters identified by all staff. The passenger lift had benefited from an upgrade. A new housekeeping manual was in preparation for housekeeping staff, to include the handyman. The home presented well in terms of cleanliness, including all bathrooms and toilets, but there were some high-risk areas, for example dirty or rusted u-bend fittings under some wash hand basins in toilets, and pipe boxings in need of re-glossing. The handyman could undertake a monthly check of such areas, perhaps backed by receipt of infection control training. It was also suggested that where toilets have been decorated in a flamboyant style, there should be a check to see that this is not to the detriment of any residents with perceptive difficulties. Minutes from night staff and housekeeping staff meetings showed there was ongoing attention to touch-point cleaning, i.e. door handles, rails etc. There was prompt attention to any odour issues. The laundry was very clean and well organised, having the benefit of a dedicated operator who also distributes clean laundry back to residents. By contrast, sluice rooms were in a poor state, especially the downstairs one where chipboard shelves were disintegrating. The additional use of this room for storage of wheelchairs made it hazardous in more ways than one. Both sluice rooms must be upgraded to meet infection control standards. A rusted toilet frame in what was formerly the Intermediate Care wing was identified for disposal. It remained the case that the smaller sitting rooms were underused. One was being used for storing furniture and hoists. Two residents were making use of another, and a visitor said their family often used this room as a venue for visiting, and they had seen various residents use it. This same visitor said they had never had concerns about cleaning standards in the home. They were also pleased with the gardens as an amenity, as were many residents spoken to. There were plans in hand for conversion of an upstairs area to a hairdressing salon, to include drink-making facilities, which would represent not only an improvement on the existing provision, but also a possible new social focus point. This had been discussed in a residents’ meeting. Several residents expressed satisfaction with their bedrooms, although many rooms presented as small and rather bare by modern standards. Furniture provided is of good quality, but room sizes militate against much choice of how to arrange or supplement it. One resident commented on disturbance caused by the sound from other residents’ televisions. Windows in most of the home, Bemerton Lodge DS0000028264.V296074.R01.S.doc Version 5.2 Page 20 including individual bedrooms, are aluminium sashes. A care leader said many residents do not use them, but have to ask staff to do so, because windows have become stiff or misaligned. This creates a risk that residents may sometimes put up with a window open or closed contrary to their wishes, hence a requirement that the windows be surveyed and made good as necessary. Bemerton Lodge DS0000028264.V296074.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. A good level of developmental training has been maintained amongst care staff, who provide consistent care to the satisfaction of residents. However, availability of staff is sometimes compromised. Recruitment practice is good. EVIDENCE: Rotas showed maintenance of a minimum of six care staff on duty on morning shifts, and five in the evenings; frequently these numbers rose to seven and six, as was the case at the time of inspection visit. Once a month, when a new batch of medicines is received and has to be booked in, eight staff are on shift, as that is a major staff-intensive task that must be completed by two people with minimal interruption. The visiting district nurses had not seen evidence of short staffing, but did regard the care leaders as pressured, especially in the mornings, at which time their actual engagement with residents was limited. Mrs Baldwin was initially appointed as “head of care”, a new staff tier recently introduced by the Trust in some of its homes. Recruitment was advanced in seeking to appoint a new head of care, the role having elements of supporting both the manager and the care leaders. In that role, Mrs Baldwin had been able to identify residents overdue for reviews, and to give priority to arranging these. Such a role lends itself to the care plan review tasks identified elsewhere in this report. Bemerton Lodge DS0000028264.V296074.R01.S.doc Version 5.2 Page 22 Despite the numbers of staff deployed, there were some shortfalls in staff availability. During the lack of staff presence over the lunch period in Wing 6 (mentioned at page 15 above), two residents with assessed risks of falling (but also with recognised strong wishes and needs for independence) left the table. Another resident in that area said he had missed telephone calls from a relative owing to lack of staff availability to answer the communal telephone at the other end of the building. Visitors, including professionals, commented on long waits to be given access to or from the building. Mrs Baldwin said she had begun to look at the impact of afternoon staff handovers on staff availability, and at how shift patterns might be made more flexible to give better crossover cover. Any time the staff on duty fall to less than six in number, the ratio to residents becomes worse than one to ten, and the residents are located over a six-wing building. It was noted that the activities co-ordinator’s hours are reserved to her task, separate from care staffing hours, and that there is some use of “care support” hours from the housekeeping staff to undertake tasks such as making beds. There are some male care staff, which enhances resident choice. Residents and visitors made only positive comments about the quality of staff, but in response to the question “are the staff available when you need them?” four out of seven survey respondents answered “usually” rather than “always”. On commencing as manager, Mrs Baldwin had identified a shortfall in medications training amongst staff, which she had addressed by arranging a variety of medications courses for all care staff. It was now planned that all care staff would receive “acting care leader” training, whether they envisaged progression of role or not; Mrs Baldwin considered that one member of staff had left for want of developmental opportunities. Of 38 care staff currently on the payroll, 15 have achieved NVQ in care to level 2 or higher, and six were working towards this. Qualification rates were lowest among relief and night care staff. Many staff spoke with enthusiasm about training received or planned. Evidence of recruitment practice was that it was safe. One member of staff had not been offered a permanent contract at the end of their probationary period, being seen as unsuitable. Bemerton Lodge DS0000028264.V296074.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 at least once during a 12 month period. 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. There is effective delegation and participation between management and the care staff team. Residents experience an open style of management, with good channels of communication and provision for safeguarding financial interests, where required. Provision for health and safety is good. EVIDENCE: Mrs Baldwin went through the registration process shortly after this inspection visit and met the criteria for registration as manager. She presented as someone committed to hearing and acting upon the views of residents, and being accessible to all staff. She has demonstrated confidence and maturity in how she has approached issues that have arisen since her appointment. For her initial period as manager, she has had the immediate support of the previous manager. Bemerton Lodge DS0000028264.V296074.R01.S.doc Version 5.2 Page 24 A planned residents’ meeting was held during the inspection visit. This was steered by Mrs Baldwin but there was much content from the resident group. Some other staff were in attendance and there was clear support to assisting attendance and participation. It could be seen that feedback from residents, through this forum and from other quality assurance measures such as the meals surveys and individual reviews, was shared with staff and used to inform developments in the home. There is also ongoing monitoring of management and care outcomes for residents by way of the provider Trust’s quality assurance systems, which include regular unannounced visits. There was no change to the satisfactory arrangements for safe keeping of residents’ monies, where they or their families had requested this. Provision for health and safety of residents and staff was good. All fire precautions records were in order. The most recent fire drill had identified points for action. Fire shutters had been fitted to each servery. All servicing of equipment was in date. The Trust has good contract systems in place, backed up in the home by a full time handyman. Mrs Baldwin had identified from regular oversight of accident records that there were a large number of “found on floor” entries. In response she had arranged a visit by a nurse from the falls clinic, to discuss falls prevention with staff. This linked with the nurse’s individual attention, at the home’s request, to some residents with identified high risk of falls, for whom risk assessments and risk reduction strategies were in place. These showed they were reviewed, for example an individual risk assessment for falls had been reduced from high to medium risk. Changes in deployment of staff could also be expected to impact on management of these risks. Bemerton Lodge DS0000028264.V296074.R01.S.doc Version 5.2 Page 25 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 3 X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 2 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 3 X X 2 2 2 2 STAFFING Standard No Score 27 2 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.V296074.R01.S.doc Version 5.2 Page 26 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 OP9 Regulation 13(2) Requirement Administration records for ‘as required’ medicines must reflect the manner in which they are used, including the time of administration. There must be sufficient staff to support residents at all times, including mealtimes. There must be a detailed survey of all external windows for safety, leading to a programme of servicing of those where risks are identified. There must be a regular audit and making good of areas presenting high-risks in terms of infection control in bathrooms, toilets and sluices. The sluice rooms must be refurbished to accord with recognised infection control guidelines. The identified rusted toilet frame must be disposed of. Timescale for action 31/07/06 2. 3. OP15 OP27 OP24 OP25 OP38 18 (1)(a) 13(4)(a,c) 31/07/06 31/08/06 4. OP26 13 (3) 31/07/06 5. OP26 13 (3) 31/10/06 6. OP26 13 (3) 30/06/06 Bemerton Lodge DS0000028264.V296074.R01.S.doc Version 5.2 Page 27 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. OP7 2. 3. 4. 5. OP9 OP12 OP14 OP21 OP26 OP30 Refer to Standard Good Practice Recommendations On reviewing care plans, combine elements of the plan where possible, and ensure removal of components that are no longer in active use. Consideration should be given to the storage of medicines, allowing space for safe working. Encourage key workers’ direct involvement in the evaluation of activity care plans. Ensure that lavatories are not decorated in such a way as to cause perceptive difficulties for any residents who may use them. Consideration should be given to involving the handy person in infection control training. Bemerton Lodge DS0000028264.V296074.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bemerton Lodge DS0000028264.V296074.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!