CARE HOMES FOR OLDER PEOPLE
Bevan House Stackwood Avenue Barrow in Furness Cumbria LA13 9HQ Lead Inspector
Marian Whittam Unannounced Inspection 28th October 2005 11:30 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 Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 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. Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Bevan House Address Stackwood Avenue Barrow in Furness Cumbria LA13 9HQ 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) 01229 894547 01229 894550 Cumbria Care Mrs Susan Balderstone Care Home 40 Category(ies) of Dementia - over 65 years of age (9), Old age, registration, with number not falling within any other category (40) of places Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 40 service users to include: up to 40 service users in the category of OP (Old age, not falling within any other category) up to 9 service users in the category of DE(E) (Dementia over 65 years of age) The staffing levels in the home must meet the Residential Forum Care Staffing Formula for Older Adults. When single rooms of less than 12 sqm usable floor space become available they must not be used to accommodate wheelchair users, and where existing wheelchair users are in bedrooms of less than 12 sqm they must be given the opportunity to move to a larger room when one becomes available. 3rd June 2005 3. 4. Date of last inspection Brief Description of the Service: Bevan House is a care home registered to care for 40 older people, 9 of who may have dementia. The home is in a residential area of Barrow in Furness, close to a local bus route into Barrow, and to surrounding areas. The home has a car park to the rear of the building and there are patio areas for service users to use. All of the home’s 40 bedrooms are single rooms and the home is divided into five units for residents. On the first floor are Langdale, Abbey and Furness units and on the ground floor are Piel and Ramsden units. Piel cares for up to 9 people with dementia and Ramsden offers respite care for up to 6 people. Each unit has a non- smoking lounge and dining area with a small kitchen attached, a bathroom and 2 separate toilets. The home has a main kitchen, sluice facilities, a laundry, two staff rooms, a hairdressing room, day centre room and bathroom and a large room used for meetings and training purposes. The home has a large lounge for communal activities. Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 6 hours; the inspector looked at a number of records, care plans and medication records, looked around the home, spent time on the units and spoke with the supervisor on duty, 15 residents, 5 staff members and a District Nurse who was visiting residents in the home. What the service does well: What has improved since the last inspection?
Despite there being short periods of time when staff levels are low the home has taken steps to try to overcome its difficulties with maintaining staff levels in the longer term and continues to work on this problem. Staff comments suggested that there are improvements in staff morale around staffing. Resident meetings are taking place regularly and residents do have the opportunity to give their views and make suggestions about what they want from the service. There is evidence that Legionella and water temperature testing is now being done regularly and recorded. During the last visit old furniture from residents rooms was on the patio blocking a fire exit and general access onto the patio. This has all been removed allowing access for residents. Decoration and improvements in the premises have improved the environment for residents and the maintenance plan shows this is going to continue.
Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Individual needs assessments had been done prior to residents coming into the home so residents could be confident that their assessed needs would be met. EVIDENCE: Assessments done before and at admission were used to plan care on admission and particular needs were being assessed and catered for. There were detailed information and risk assessments in place that gave a clear picture of what individual residents needed. Where needed other agencies or health care professionals were included in assessing and meeting needs. Care management assessments from social services were also in place. Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 The health and personal care needs were being identified in individual care plans and met for residents. Medication records and systems needed some improvement to make sure that residents were not at risk. Personal care and support was being given in a way that respected resident’s privacy, dignity and personal choice. EVIDENCE: All residents have individual care plans in place and these give a good indication of what individual needs are and their personal preferences and choices. The plans had been regularly reviewed and updated to reflect changes. Discussions with staff and residents and observation of practices suggested that staff were aware of residents needs because of their knowledge of particular residents specific needs and preferences. There was a good rapport between staff and residents. One resident said that they had not wanted to come in but staff had been supportive and taken time to explain things and now would not like to be anywhere else. Residents spoken with felt staff respected their choices and personal dignity and their needs were being
Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 10 met. One resident said that staff were friendly and always asked them what they wanted to do or eat. Healthcare needs were being identified and met with a good working relationship with GPs, nurses and other agencies. A visiting district nurse commented positively on the homes early involvement of nursing services for pressure area care and continence needs of residents. Medication record systems must be improved to make sure all prescribed medications administered by staff are recorded, such as the application of creams and lotions. The reason must also be recorded on the MAR (medication administration record) when a medication has not been given and the dose of medication given must be recorded where this varies. Medication must always be signed for when it is administered. There was one resident whose medication had not been available for 5 days. A continuous supply of resident’s medication must be provided. This was happening despite evidence of staff requesting repeat supplies from GPs and the dispensing pharmacy. Senior care staff on duty showed how they had identified problems associated with the provision of some medicines. For good practice, the arrangements in place to supply medication should be reviewed by the manager and the supplying pharmacist and GPs consulted so the systems in use can fully meet the needs of the residents and provide a timely and responsive service. There are residents who prefer to give their own medication where possible and staff support them in this and provide safe storage. However, the manager must make sure that a full risk assessment of the situation is done. Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 The home provides social and individual activities and staff support residents in making choices in their daily lives. The home offered a varied menu and choice of food and catered for special dietary needs. EVIDENCE: The home provides some regular social activities, recorded resident’s hobbies and interests and organised special social and religious events. Residents said that they could come and go as they pleased and see who they wanted. The supervisors took the responsibility for organising and consulting residents about activities and social events. Care staff on the units help residents according to their needs with one to one and small group activities in addition to their personal care duties. Carers were helping residents with group activities, one group of residents enjoyed playing dominoes and residents said they enjoyed these and looked forward to them. Residents enjoyed the regular bingo sessions. Residents enjoyed the craft sessions organised by a carer and had produced work of a high quality. One resident said they were happy just sitting here watching the television. Suggestions had been put forward at the last residents meeting on Christmas activities and these were being acted upon.
Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 12 Residents spoken with said they liked the food in the home and those spoken with felt the food was “good” and “very good”. The menus show a nutritious diet with fish, meat, vegetables, milk, cheese dishes and fruit available. Following comments at the last residents meeting a broader range of meals is being offered including curries and sweet and sour dishes that residents enjoy. All spoken with agreed there was a choice of food each day and that there was plenty to eat and drink when they wanted it. One resident said that they had never drunk so much tea until coming into the home. Another resident said that they liked to have cheese and crackers in the evening whilst watching the television. Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home has a satisfactory complaints system and a procedure was available. Residents felt confident that the manager would listen to them and act to deal with their concerns. EVIDENCE: The home has a complaints procedure in place and also information leaflets on making a complaint to Cumbria Care. The home logged formal complaints for investigation and follow up. The information and procedure are available to residents and visitors to the home. Residents spoken to were confident that the manager or supervisor would deal with any complaints they made. Residents spoken with said they did not have anything to complain about. Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25 and 26 The home provides a clean, homely, well decorated, appropriately furnished and adequately maintained environment for residents. There is equipment in the home to promote resident mobility and independence. EVIDENCE: There is a maintenance plan in place and a programme of continuing redecoration of resident’s rooms and communal areas. Some rooms in the home have been redecorated and new furniture had been provided for residents, improving their environment and comfort and the homely appearance of communal areas. The dining and lounge areas on the units were being used for activities and residents said they enjoyed being able to mix socially on the units and some were visiting units for a chat with other residents and staff. Residents were pleased with the improvements that had been made in their bedrooms and in the home generally. Further improvements are planned to provide a separate room for smokers with an extraction system to improve shared facilities for all residents.
Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 15 Resident’s said that they liked their bedrooms and one resident said, “I love my little room and have all my stuff”. Many residents have their own possessions and this makes their rooms more personal and homely. There is a range of equipment and adaptations in the home to help residents make the most of their independence and to get about the home. Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 16 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 The deployment and number of staff available on the rota has improved but is still not always sufficient to safely meet the needs of the residents. There are shifts when a minimum level of staff is not maintained and this has a potentially detrimental impact on providing a consistent and safe standard of care for residents. EVIDENCE: Staff say that the system of using ‘floaters’, staff who move from unit to unit and go where needed or to cover sudden absences has helped to relive staff shortages and provide more consistent staff cover. The home has recruited new staff and is trying to recruit more. However, there are still times during shifts when staff levels are inadequate. Staff help each other out when this happens but on the EMI unit there was only one carer on duty from 1pm to 2pm during the inspection. The floater had gone off duty and there was no one to cover. By moving staff around at such times supervisors have tried to prevent this happening but on the day of the inspection could not do so with the staff hours available to them. If EMI resident’s needs are to be properly and safely met then there must always be sufficient numbers of staff on duty throughout the shift with appropriate skills and experience to meet resident’s individual needs. Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 17 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): 33 and 35 The home reviews aspects of its performance through reviews, quality surveys and regular resident consultation to affect the way the service is run. There are policies and procedures in place to protect resident’s personal and financial interests. EVIDENCE: Regular residents meeting were taking place in the home allowing resident’s a way to get their views and opinions across. The home plans head and budgets for development and improvements and reviews its procedures at a corporate level. Policies, procedures and established practices are in place to safeguard resident’s finances. The home does not act as agent for any residents. Some residents handle their own financial affairs and are supported in this. The home holds only small amounts of resident’s personal spending money and this is recorded and receipted and kept securely.
Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 18 There are health and safety procedures in place and evidence that Legionella and water temperature testing being done. Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 19 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 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 X 3 X X X X X 3 3 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X X Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement Prescribed creams and lotions must be recorded following administration. (Previous timescale of 30.06.05 not met) The reason why a medication is not given must always be recorded on the MAR chart. The person administering the medication must sign the record immediately after giving it. Where the dose of any prescribed medication varies the number given must be recorded on the chart. A continuous supply of medication must be provided for residents. A risk assessment must be done for all for all residents who selfmedicate. At all times there must be enough care staff on duty on each unit appropriate to the assessed needs of residents. (Previous timescale of 30.06.05 not met) Timescale for action 14/11/05 2. 3. OP9 OP9 13 (2) 13 (2) 30/11/05 30/11/05 4. OP9 13 (2) 30/11/05 5. 6. OP9 OP9 13 (2) 13 (2) 30/11/05 30/11/05 7. OP27 18 (1) 30/11/05 Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 21 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 OP9 Good Practice Recommendations The manager should consult with the supplying pharmacist and GPs about the problems staff have identified with the provision of some medicines. Bevan House DS0000035555.V255738.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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