Inspection on 28/09/05 for Bexton Court

This inspection was carried out on 28th September 2005.

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

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

Other inspections for this house

Bexton Court 21/09/09

Bexton Court 31/10/08

Bexton Court 25/09/08

Bexton Court 10/09/07

Bexton Court 11/05/06

Bexton Court 18/05/05

Bexton Court 12/10/04

Bexton Court 24/05/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOMES FOR OLDER PEOPLE Bexton Court Bexton Court Bexton Road Knutsford Cheshire WA16 OBZ Lead Inspector Sue Dolley Unannounced Inspection 28th September 2005 09:00 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 Bexton Court DS0000036255.V254242.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. Bexton Court DS0000036255.V254242.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bexton Court Address Bexton Court Bexton Road Knutsford Cheshire WA16 OBZ 01565 651725 01565 755750 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) Cheshire County Council Care Home 23 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (22), Learning disability over 65 years of age (1) of places Bexton Court DS0000036255.V254242.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 23 service users to include: * Up to 22 service users in the category DE(E) (Dementia over 65 years of age) * Within the 22 DE(E) service users 5 may be in the category DE (Dementia aged between 55 and 65 years) * No more than 1 service user may be accommodated in the category LD(E) (Learning disability over 65 years of age) The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection 18th May 2005 2. 3. Date of last inspection Brief Description of the Service: Bexton court is a purpose built community support centre owned and managed by Cheshire County Council. It is near to Knutsford Town Centre, where there are a wide range of shops and other amenities. Bexton Court provides accommodation on a single floor with some office accommodation sited on a second floor. The premises are physically linked to a ward in the adjoining hospital. The home is registered to provide care to a maximum of 23 service users. Bexton Court is a developing provision. It is a well-equipped facility offering a range of short- term respite services for people with dementia, which are tailored to an individual’s needs. Care can include short breaks, flexible day and overnight care. There is a day care unit, which provides 5 places each day from Monday to Friday. In Bexton Court, all rooms are easily accessible to wheelchair users. All bedrooms have wash hand basin facilities, with hot and cold water, door locks and facilities for calling staff should assistance be needed. There are several specially equipped bathrooms with bath and shower facilities. There is a secure garden area for service users and visitors to use. Bexton Court DS0000036255.V254242.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 28th September 2005 over 7 hours to assess if service users’ needs were being met. A partial tour of the premises included 5 bedrooms, shared areas such as lounges and dining area, and the kitchen. What the service does well: What has improved since the last inspection? The service is establishing itself as a valuable resource within the area and demand for short stay and day care has steadily increased. Much staff training continues to take place. Formal and observational staff supervision is being further established. The aim is to continue to build upon the level of skill and experience within the staff team and to support the staff in their work. Bexton Court receives support from a Specialist Practitioner Nurse each Tuesday and a Registered Mental Nurse each Wednesday. This input from Eastern Cheshire Primary Care Trust has proved to be beneficial to service users, their relatives and staff. It has aided the assessment and review process and the liaison with General Practitioners. The new team manager at Bexton Court is planning to hold a monthly structured support group for relatives and carers. Bexton Court DS0000036255.V254242.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. Bexton Court DS0000036255.V254242.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 Bexton Court DS0000036255.V254242.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): 1,4,5,6 Service users and their carers are provided with useful information about Bexton Court to enable them to make an informed choice about using the community support centre and the services it provides. The assessment process is thorough and well managed to ensure that the people, who stay at Bexton Court, and their relatives, know what to expect and that their needs will be met. Prospective service users and their carers are encouraged to visit the centre to view the facilities and meet with staff to assess the suitability of centre before accepting a service. EVIDENCE: The centre seeks to offer varied and flexible services to dementia suffers and their carers in the area. A well-written statement of purpose was available for inspection setting out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the centre. A separate service user guide has been produced in colour, which is presented in a clear, concise, easy to read format with picture symbols to complement the text. The document provides useful information to explain the service, the accommodation and care provided. Bexton Court DS0000036255.V254242.R01.S.doc Version 5.0 Page 9 All service users’ needs are assessed before they receive care at the centre. Bexton Court gathers information from the potential service users, their relatives, social services and health care representatives to ensure individual assessed needs can be met. 4 service users’ care files were checked. Each service user had been admitted following a full and thorough assessment of need and each had an individual plan of care including information from health and social services. Good records of visits by health care professionals were kept and assessments and care plans were positively written. Self -care abilities were accurately described, useful social and medical history information was provided. Service users’ interests were described and important contacts were recorded. Each care file contained a photograph of the service user to aid identification. Two of four forms relating to medication at admission had not been fully completed and two of four forms relating to functional ability were also incomplete and therefore did not accurately reflect changing care needs as identified in the daily records. The team manager was advised of this at feedback to the inspection. Following discussion about information contained in care records the team manager will ascertain if sufficient care staff have had relevant and up to date training in catheter care and regarding the care of service users who may have visual or auditory hallucinations. Prospective service users and their carers are invited to visit the centre to meet with staff, to look at the facilities and check the suitability of the centre prior to making a decision to accept day care or a trial stay. The team manager had written to existing users of the service and their relatives to introduce herself and to encourage discussion and offer support. Bexton Court does not provide intermediate care, therefore National Minimum Standard six does not apply. Bexton Court DS0000036255.V254242.R01.S.doc Version 5.0 Page 10 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): 8, 9 Service users are looked after very well in respect of their health and personal care needs and family carers are also supported. Service users are closely monitored, with potential health problems promptly addressed by the appropriate health care services. The recording, administration and stock control of medication needs to be improved, to establish whether all service users receive their medication as prescribed. EVIDENCE: Each of four service user files checked contained a plan of care which set out in detail the action to be taken by care staff to ensure all aspects of service users health, personal and social care needs were met. The care records provided information regarding medical history and ongoing investigations. There was evidence of careful health monitoring and of staff promptly seeking professional medical help and advice to address the existing and changing health needs of service users. One service user had complained of having a sore toe of two separate dates but there was no record of a health care visit to investigate the cause. Advice was given regarding this omission. Bexton Court DS0000036255.V254242.R01.S.doc Version 5.0 Page 11 Staff members had recorded any significant events and visits by health care professionals were thoroughly recorded to enable staff to provide continuity of care and support. Bexton Court currently receives support from a Specialist Practitioner Nurse each Tuesday and a Registered Mental Nurse each Wednesday. This input from Eastern Cheshire Primary Care Trust has proved to be beneficial to service users, their relatives and staff. It has aided the assessment and review process and the liaison with General Practitioners. The care records checked reflected the care given throughout the day and night. Records relating to nighttime observations provided details of any sleep disturbance and of any reassurance and care provided. Some staff members had received training in catheter care. Following discussion at feedback to the inspection, the team manager intends to ensure this training is updated and may arrange catheter care training for additional staff members. Some care records indicated that service users had experienced auditory and visual hallucinations but it was unclear if staff had had training to know how to help service users experiencing these difficulties. Again the team manager will ensure staff have had or will receive appropriate training. Forms to record functional ability were provided within each care file. Some of the forms had not been fully completed and consequently fluctuating ability was not accurately monitored and reflected. The functional ability assessment information did not always correspond with or reflect the information provided in the daily records. See Recommendation 1 The medication administration records contain photographs of each service user to aid identification. The medication administration records and some medication stocks were checked. Improvements to recording and stock control are necessary. Some care records did not indicate that medication had been booked in upon admission. Staff members were found to be using different ways to record medication to be taken as and when required. There were unexplained gaps in the recording of medication and omission code ‘F’ was used on a number of occasions without the reason for use being defined. Confusingly each medication sheet related to a four- week period and each week was numbered from one to four with the days numbered from 1 to 7 instead of each day being identified by a date. One bottle of medication stored as a controlled drug was not recorded and had not been returned to the service users carer following a recent short stay. Some medication records dating from January 2001 to December 2004 were awaiting storage. See Requirement 1. Bexton Court DS0000036255.V254242.R01.S.doc Version 5.0 Page 12 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): 13 A high level of liaison and communication is maintained between service users, their relatives and staff, to ensure daily routines are maintained and residents are enabled to maintain contact with people important to them. EVIDENCE: Service users are able to have visitors at any reasonable time and during the inspection there were several visitors to Bexton Court to visit relatives and to view the premises and facilities for the first time. Service users were enabled to meet with their visitors in private and staff took time to welcome visitors and to keep them informed as necessary. There was evidence of a close liaison between the staff at Bexton Court and family supporters. When family carers telephoned to speak with staff they were provided with clear information and received a friendly reassuring response. Service users are aided to maintain contact with their family and friends. Staff members appreciate the importance of sharing the care responsibilities and of learning from family supporters to maintain usual care routines and to enable them to provide individualised care. Bexton Court DS0000036255.V254242.R01.S.doc Version 5.0 Page 13 The team manager is currently planning to hold a structured support group for relatives and carers to be held once a month on a Wednesday. This is will enable carers to meet with other people in similar circumstances and provide an opportunity for relatives and carers to access advice, support and any relevant training. Bexton Court DS0000036255.V254242.R01.S.doc Version 5.0 Page 14 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): 17 and 18 Information is provided regarding a local advocacy service, which aims to enable service users to express their needs and choices, to represent their wishes and protect their rights. Arrangements are in place to protect service users and to respond to their concerns; to ensure they stay safe and are satisfied with their care. EVIDENCE: Service users and their relatives and friends can be provided with leaflets from the Alzheimer’s disease Society and Age Concern to explain about available advocacy services. The leaflets are readily available in the reception area. Bexton Court uses Cheshire County Council’s Complaints procedure and this is well advertised throughout the home and in the information supplied to carers. The recently updated Department of Health guidance ‘No Secrets’ was available within the home and plans had been made for ten members of staff to attend protection of vulnerable adults training on the day after the inspection. A whistle blowing policy is available to staff to enable them to respond appropriately to any suspicions or evidence of abuse. Staff members are aware of various forms of possible abuse and have received written information on the various ways service users can be safeguarded and protected. Bexton Court DS0000036255.V254242.R01.S.doc Version 5.0 Page 15 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): 19,23 and 24 Bexton Court is well maintained and clean with only a few areas requiring attention to decoration and repair. The centre is bright and airy and is furnished to a good standard which helps to create a comfortable and welcoming environment. EVIDENCE: Bexton Court provides ground floor accommodation for service users. There is some office accommodation on the second floor. Service users’ rooms are in two wings. There are twelve rooms in wing 1 and eleven rooms in wing 2. Bedroom sizes are adequate and bedrooms are well equipped. There are various layout options to suit individual needs. Ample communal space is provided for various social activities and there is a large secure garden available for both service users and visitors. Bexton Court DS0000036255.V254242.R01.S.doc Version 5.0 Page 16 All bathroom areas are easy to access and well equipped. The heating and lighting is satisfactory throughout the premises and an emergency lighting system is provided and maintained. The laundry is well organised and protective clothing is provided for visitors to the orderly, well-equipped kitchen. A call alarm system is in place throughout the premises. Some pressure mats are in use and bedroom doors can be alarmed to monitor movement to and from bedrooms, to help keep service users safe without restricting their movement. The premises are generally maintained to a good standard, attractively decorated with good quality furniture and furnishings. Some areas were identified as in need of redecoration at the last inspection. These remain unchanged and include the following • The lower walls of the dining area and the area outside the office need redecoration. • The ceiling of the medication room was damaged by a water leak and needs redecoration. • Four bedrooms need redecoration. • One bedroom has some damage to the window recess and window board. See Requirement 2. Bexton Court DS0000036255.V254242.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 Appropriate staff training is provided to ensure staff members are trained and competent to do their jobs. EVIDENCE: Cheshire County Council is committed to providing training opportunities to ensure staff members have the appropriate skills and knowledge to deliver the necessary level of care to service users. There is a well- established induction procedure for new staff members including checklists to ensure all aspects of the induction training are satisfactorily completed. Detailed training schedules are kept for each staff member. Of forty staff members, eight have had recent Emergency Aid training and six have had recent Food Hygiene training. Various training has been planned to take place within the coming weeks and will include Fire Instruction, Protection of Vulnerable Adults, Risk assessment and Supervision training. Additional Infection Control training is to be planned. Senior carers are trained to give medication and this training is updated as necessary. Observational supervision sessions are also to be introduced in the near future to assess practice and competence and to identify training needs. Bexton Court DS0000036255.V254242.R01.S.doc Version 5.0 Page 18 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): 31,35 and 38 The proposed registered manager is well qualified and is an experienced and has the ability and enthusiasm to discharge her responsibilities fully. There are safeguards in place to protect the financial interests of service users within the centre. Bexton Court has good organisation systems in place and clear lines of accountability. It runs in the best interests of service users and promotes and protects their health, safety and welfare. EVIDENCE: A new team manager is in post. She has worked in various caring environments for a period of eighteen years. Previously she has managed domiciliary care services and a specialist home for people with dementia. The team manager has been proposed as registered manager and awaits the fit person process and interview to achieve this status. The team manager and other senior staff are familiar with the conditions and diseases associated with old age and share their knowledge and experience with the staff group. Bexton Court DS0000036255.V254242.R01.S.doc Version 5.0 Page 19 There are clear lines of accountability within the home and with external management. Suitable accounting and financial procedures are in place to safeguard service users money. Short stay service users and their supporters normally manage their own money and only a small amount of personal allowance money is kept within the home to pay for hairdressing costs and to make small purchases from the trolley shop. All individual balances were checked. The written records and balances corresponded and were accurate. Receipts were available for all transactions. The fire fighting equipment had been regularly serviced and the fire precautions record book was maintained and showed all fire safety checks. Accidents records were well maintained. Individual and home risk assessments were available and had been thoroughly undertaken to try to ensure the health and safety of service users and staff. Bexton Court DS0000036255.V254242.R01.S.doc Version 5.0 Page 20 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 3 X X 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 3 2 X X X 3 2 X X STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 Bexton Court DS0000036255.V254242.R01.S.doc Version 5.0 Page 21 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 Requirement Arrangements must be made for the accurate recording and administration and stock control of medication. (Previous timescale of 23 May 2005 not met) All areas of the home must be kept clean and must be reasonably decorated. (Previous timescale of 8 August not met) Timescale for action 28/11/05 2 OP24 23 28/12/05 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 OP8 Good Practice Recommendations Ensure service users functional ability is regularly assessed by a person trained to do so and ensure the outcome and their progress are accurately recorded to identify and reflect changing abilities. Bexton Court DS0000036255.V254242.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Bexton Court DS0000036255.V254242.R01.S.doc Version 5.0 Page 23 - 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!