CARE HOMES FOR OLDER PEOPLE
Bickham House Green Walk Bowdon Altrincham Cheshire WA14 2SN Lead Inspector
Helen Dempster Unannounced Inspection 12th January 2006 12:00 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 Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 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. Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Bickham House Address Green Walk Bowdon Altrincham Cheshire WA14 2SN 0161 928 2514 0161 941 6873 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) Bickham House Trust Mrs Cathrine Susan Myers Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th September 2005 Brief Description of the Service: Bickham House is a large detached Victorian property, which was bequeathed to the community of Bowdon in 1951 as a home for older people. It operates as a registered charity with a Board of Trustees and a Management Committee. Mrs Cathrine Myers is the Registered Manager. Bickham House is situated in the quiet and exclusive district of Bowdon. The home is close to the local village shops and is within easy reach of Altrincham, public transport and the local motorway network. Bickham House provides personal care for up to twenty-two (22) older people, over a twenty-four hour period, in comfortable spacious surroundings. All bedrooms are single rooms and the residents enjoy the benefit of a large and well-maintained garden, which is fully accessible. Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the second unannounced inspection for the year. It was carried out on 12th January 2006 from midday to 3.45pm. Time was spent talking with a member of management team, staff, residents and one resident’s relative. This included discussing welfare matters relating to the residents the home supported and examining documentation in relation to the running of the home, the management arrangements, staffing, care planning and the residents’ satisfaction. The term of address preferred by the users of the service was confirmed as “residents”. It was felt this best reflected the function and purpose of the service. The inspection only looked at a limited number of standards, so this report should be read together with the earlier report to get a full picture of how Bickham House is meeting the needs of the residents. What the service does well:
Residents and a visiting relative spoke highly of the home. Residents said that the staff were good and the relative said that the home was “excellent” and the staff were “excellent. The relative added that she would be happy to live there herself. The environment was homely and attractive. Care plans included a detailed social history and information about residents’ social needs, which is good as it makes staff aware of what was, and is, important to individual residents. The home was well run by a committed manager who ensured that the staff had good access to staff training. Each member of staff had a comprehensive training file, which included very detailed induction and foundation training records and training course certificates and staff files included a very helpful checklist to track information. This is good practice. The home met the minimum standard of 50 of staff holding an NVQ qualification. The monthly newsletter was good. Residents, their relatives and friends and staff contributed to this. It included information about social events and birthdays, current affairs and poems written by residents and relatives, which included their views on events at the home Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
Residents’ needs were assessed and documented. However, information from the needs assessment did not always transfer to the care plan in sufficient detail. Risk assessments had improved, but were in need of further development to include all areas where individual residents may be at risk. It was recommended that recording systems were reviewed so that the person delivering the care and/or witnessing an event, makes the record Some aspects of kitchen hygiene, including not always covering food in fridges, had the potential to put residents at risk. An audit was needed to aid planning of training. Some aspects of storage of records needed reviewing. This included securing sensitive and confidential information, including copies of CRB checks. The home needed to develop a quality assurance system to provide a verifiable method, which involves residents, to audit the service and enable peoples’ views of the service to be collated and acted upon. Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 Page 7 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. Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 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 Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 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 Residents’ needs were assessed and documented. However, information from the needs assessment did not always transfer to the care plan in sufficient detail. EVIDENCE: The home takes basic information from people enquiring about vacancies at the home, including the GP details, medical history and any special circumstances. A fuller needs assessment is then completed prior to the admission of the new resident. Since the previous inspection, the assessments were held with the care plan, which is good practice. The assessments sampled were found to be detailed and helpful. However, as noted at the previous inspection, this detailed information was not consistently linked with the care plan and some assessments were not dated. Advice was given and the requirement made at the previous inspection was repeated. Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 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): 7 and 9 The residents benefited from having improved care plans, risk assessments and medication practices. However, these benefits were being slightly compromised by not all areas of care being supported by a risk assessment. EVIDENCE: The care plans included basic information and next of kin details, personal care details, records of medical treatment, visiting professional visits including optical and chiropody. The plan also contained a pen profile, “water low” score, weight chart, hygiene and grooming chart, moving and handling risk assessment form, key worker report and daily record sheets. The care plans sampled would benefit from being more person centred and from covering all aspects of needs noted on the needs assessment (See Standard 3 for details). As noted at the previous inspection, a particular strength of care plans was the detailed social history and level of detail concerning social needs, which is commendable as it makes staff aware of what was, and is, important to individual residents. Records sampled were made on a daily basis. Most of the daily records were made by senior staff, rather than the care staff who were delivering the care. There were some separate keyworker records made on a broadly monthly
Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 Page 11 basis. It was recommended that recording systems were reviewed so that the person delivering the care and/or witnessing an event, makes the record Risk assessments had improved since the previous inspection. However, there were still risks applicable to residents which had not been assessed and documented. One example was bathing. There were moving and handling assessments in place, but these did not fully cover bathing, as a tick box was used to indicate whether one or more carers were needed to assist, without any details of the need. Details of residents’ preferences regarding bathing and associated risks e.g. regarding water temperatures, having a soak in the bath or being left in privacy were not documented in the examples sampled. The requirement made at the previous inspection concerning the need to review risk assessments to include all risks applicable to an individual resident was therefore repeated. It was, however, noted that in response to a requirement made at the previous inspection, risk assessments were being reviewed on a monthly basis. This is good practice. Since the previous inspection, the home had obtained the residents’ GPs approval, in writing, to administer homely remedies medication. The care plans included detailed information about side effects of prescribed drugs. In response to a requirement made at the previous inspection, care plans had been extended to include a care plan for the administration of medication, including when required” (PRN) medication. Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 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): N/A EVIDENCE: These standards were assessed at the previous inspection and will be assessed again at the next inspection. Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 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): The home had increased staffs’ familiarity with the “Protection of Adults from Abuse Policy” to enhance residents’ safety. EVIDENCE: In response to a requirement made at the previous inspection, Trafford Council’s Protection of Adults from Abuse Policy was readily available at the time of inspection. There was evidence to suggest that staff had received training in the protection of adults from abuse. The home also used the “Skills for Care” training video on adult protection. Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 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): 26 The environment was homely, attractive and overall, it was clean. However, some aspects of kitchen hygiene practice had the potential to put residents at risk. EVIDENCE: Residents expressed their satisfaction with the environment, which was attractive and homely. At the previous inspection, the walls, ledges, floors and the fridge were in need of deep cleaning. This had been addressed. A hygieneauditing tool was in place, but this needed to be used consistently. Some food in the fridge was not covered and dated and the canopy above the cooker needed cleaning. A requirement was made accordingly. Following the inspection, the manager stated that the canopy was due to be cleaned and that contract cleaners are employed each Wednesday to deep clean the kitchen Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 Page 15 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): 28, 29 and 30 Access and commitment to staff training was good. This good practice would be enhanced by completing an audit to aid planning of training. EVIDENCE: Of the 19 care staff, senior carers and officers, 1 had NVQ Level 4, 2 had NVQ Level 3 and 7 had NVQ Level 2. This meets the minimum standard of 50 of staff holding an NVQ qualification. A number of staff files were sampled to assess recruitment procedures. Concern was expressed that sensitive and confidential information, including copies of CRB checks was not held in a locked cabinet. A requirement was made accordingly. Overall, staff files were found to be comprehensive and included the application form, references, evidence of CRB checks, contacts, terms and condition and evidence of staff signing for receipt of the staff handbook. A very helpful checklist was in place on each file to track information. This is good practice. Each member of staff had a comprehensive training file, which included very detailed induction and foundation training records and training course certificates. This good practice would be enhanced by completing an audit of training. This would facilitate ease of planning training and would ensure that
Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 Page 16 training, including mandatory training, is updated as required. A recommendation was made accordingly. Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 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): 31, 33, 35 and 38 The home was well run by a committed manager who sought residents’ views and had made improvements to the management of residents’ finances and fire safety practice, which benefited residents. Development of a quality assurance method would enable peoples’ views of the service to be collated and acted upon. EVIDENCE: The manager has managed the home since June 2003. She achieved the Registered Managers Award in July 2005. She was not present during the inspection but there was evidence to suggest that she manages the home well, gives direction to staff and maintains records well. The manager had recruited a deputy manager just prior to the inspection. A detailed job description had been compiled for this post. This included supporting the manager to meet CSCI requirements.
Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 Page 18 The home had a number of systems for obtaining residents’ views. These included informal, one to one chats with residents, residents meetings, staff meetings and exit interviews with staff. One area of good practice was the use of a monthly newsletter, to which residents, their relatives and friends and staff contributed to. This included information about social events and birthdays, current affairs and poems written by residents and relatives, which included their views on events at the home. One example was a poem written by a resident’s relative about Christmas Day at the home. The home needed to incorporate this good practice into the review and development of a quality assurance system to provide a verifiable method, which involves residents, to audit the service. A requirement was made accordingly. In response to a requirement made at the previous inspection the home had introduced the use of individual receipts for all purchases made on behalf of residents. This good practice had been further developed to include a numbered receipting system for ease of audit. In response to a requirement made at the previous inspection, fire safety practice at the home had also improved. This included reviewing the fire risk assessment and completing and recording fire safety checks consistently. Good practice was seen. This included documenting individual resident’s needs and support required in case of fire and all staff signing the fire risk assessment to confirm that they had read and understood it. Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 x 17 X 18 3 X X X X X X X 2 STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 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 OP3 Regulation 14 Requirement Information from the needs assessments must inform, and be linked with, the care plan. (Previous timescale of 30/10/05 not met). Risk assessments must be reviewed to include all risks applicable to an individual resident. (Previous timescale of 30/10/05 not met). A hygiene auditing tool must be consistently in use in the kitchen. The extractor hood in the kitchen must be consistently cleaned and food must be covered and date labelled once opened. The home must review and develop their quality assurance system to provide a verifiable method, which involves residents, to audit the service. Timescale for action 13/02/06 2. OP7 13 13/02/06 3 OP26 16 13/02/06 4 OP33 24 13/06/06 Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 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 2 Refer to Standard OP7 OP 30 Good Practice Recommendations It is strongly recommended that recording systems are reviewed so that the person delivering the care and/or witnessing an event, makes the record. It is recommended that an audit of training is completed to facilitate ease of planning of training. Bickham House DS0000005598.V275516.R02.S.doc Version 5.1 Page 22 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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