CARE HOMES FOR OLDER PEOPLE
Bickham House Green Walk Bowdon Altrincham Cheshire WA14 2SN Lead Inspector
Helen Dempster Unannounced Inspection 20th September 2005 10:00 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.V251217.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. Bickham House DS0000005598.V251217.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Bickham House Address Green Walk Bowdon Altrincham Cheshire WA14 2SN 0161 928 2514 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.V251217.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th December 2004 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.V251217.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out on 20th September 2005 from 12 midday to 5pm. Time was spent talking with a member of management team, staff, residents and their relatives and friends. 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. What the service does well:
Residents’ health, personal and social care needs were documented through a comprehensive care plan. A particular strength of care plans was the detailed social history and level of detail concerning social needs. This was commendable as it makes staff aware of what was important to individual residents. Records were made on a daily basis and were clear and detailed. The record for a resident admitted a few weeks prior to the inspection gave a clear picture of the individual’s settling in period and progress which is good practice. Residents confirmed that they were treated with respect and that their right to privacy was upheld. The home has an open visiting policy and residents and visitors confirmed that the home welcomes visitors. Local churches visit the home on a broadly weekly basis. The residents have information on advocacy services, the home holds a record of personal possessions and residents have access to their care plan. The home has a 4-week rotating menu, which offered a varied and wholesome diet with alternative choices. A clear complaints procedure was readily available to allow residents to raise concerns. Residents, a resident’s friend and financial advisor all said that the staff at the home were very good and did meet residents’ needs. Bickham House DS0000005598.V251217.R01.S.doc Version 5.0 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 were in need of development and the review of care plans and risk assessments was not frequent enough to consistently update changing needs on the records. Some aspects of medication practice had the potential to put residents at risk This could be addressed by returning medication to the pharmacist when changes were made, obtaining residents’ GPs approval to administer homely remedies and developing a care plan for the administration of medication, including when required” (PRN) medication. Staffs’ lack of familiarity with the “Protection of Adults from Abuse Policy” had the potential to compromise residents’ safety. Two weeks prior to the inspection an extractor canopy had been fitted in the kitchen. The walls and ledges in the kitchen were covered in plaster dust and debris and walls, floors, ledges and the fridge were in need of deep cleaning. An immediate requirement was made accordingly. The home was advised of the need to hold individual receipts for transactions for each resident and an individual record of valuables kept for safekeeping on behalf of each resident. The home was not undertaking and recording checks of the means of escape and emergency lighting and a fire risk assessment was not readily available. An immediate requirement was made accordingly. Bickham House DS0000005598.V251217.R01.S.doc Version 5.0 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.V251217.R01.S.doc Version 5.0 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.V251217.R01.S.doc Version 5.0 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 and 6 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 has an enquiry sheet, which was used to take basic information from people enquiring about vacancies at the home, including the GP details, medical history and any special circumstances. A fuller needs assessment was completed prior to the admission of the new resident. The needs assessments were not held with the care plan and some of the information on the needs assessment was not linked to the care plan. One example was a resident who, according to the manager on duty, was admitted due to confusion and short term memory loss. This information was not included in the plan of care. The home does not provide intermediate care. Bickham House DS0000005598.V251217.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): 7,8,9 and 10 Residents’ health, personal and social care needs were documented through a comprehensive care plan. However, risk assessments were in need of development and the review of care plans and risk assessments was not frequent enough to consistently update changing needs on the records. Residents’ right to privacy and respect was upheld. Overall, medication practice was appropriate. However, some aspects of medication practice had the potential to put residents at risk. 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. A particular strength of care plans was the detailed social history and level of detail concerning social needs. This is commendable as it makes staff aware of what was, and is, important to individual residents.
Bickham House DS0000005598.V251217.R01.S.doc Version 5.0 Page 11 Records were made on a daily basis and were clear and detailed. The record for a resident admitted a few weeks prior to the inspection gave a clear picture of the individual’s settling in period and progress which is good practice. While risk assessments were in place, these needed reviewed to include all risks applicable to an individual resident, including the risk of falls. A requirement was made accordingly. Risk assessments were being reviewed on a 6 monthly basis. Risk assessments and care plans should be reviewed on a monthly basis. A requirement was made accordingly. Medication was administered from monitored dosage bubble packs. At the time of inspection, the GP had changed the dose of one resident’s medication. The manager on duty had removed some tablets from the bubble pack and resealed it. This was unsafe practice and must cease as there was no description of the tablets on the pack and the pack should have been returned to the pharmacist for the amendment to be made. A requirement was made accordingly. The home was using a range of homely remedies. The need to obtain residents’ GPs approval, in writing, to administer this medication was discussed to ensure the residents safety. The care plans included detailed information about side effects of prescribed drugs. This good practice needed to be extended to include a care plan for the administration of medication, including when required” (PRN) medication, which confirms why medication is prescribed and in what circumstances and for what conditions, PRN medication is given. A requirement was made accordingly. Residents confirmed that they were treated with respect and that their right to privacy was upheld. Bickham House DS0000005598.V251217.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): 12,13,14 and 15 The home had good methods, including a monthly newsletter, for informing and consulting residents. Visiting arrangements were appropriate and residents’ recreational interests were documented and accommodated where possible. Residents enjoyed a nutritious and appealing diet with alternative choices. EVIDENCE: The recording of detailed social histories was a strength of the home as it ensured that staff had knowledge of hobbies and social contacts that were important to each individual. At the time of inspection, 2 residents were attending functions outside the home and a hairdresser had been arranged to meet these individuals’ needs. The home has an open visiting policy and residents and visitors confirmed that the home welcomes visitors. Local churches visit the home on a broadly weekly basis. The residents have information on advocacy services, the home holds a record of personal possessions and residents have access to their care plan. Since the previous inspection, the home had introduced a monthly newsletter which detailed news about staff, residents, birthdays, world events, current
Bickham House DS0000005598.V251217.R01.S.doc Version 5.0 Page 13 affairs needs and planned entertainment. This good practice had been well received by residents and is commendable. The home has a 4 week rotating menu which offers a varied and wholesome diet with alternative choices. Residents said that the food was good and the inspector sampled a meal of steamed fish and vegetables, which was hot and tasty. All residents have breakfast in bed unless they choose to eat in the dining room. Bickham House DS0000005598.V251217.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): 16 and 18 A clear complaints procedure was readily available to allow residents to raise concerns. Staff’s lack of familiarity with the “Protection of Adults from Abuse Policy” had the potential to compromise residents’ safety. EVIDENCE: The home had a complaints policy and procedure, a copy of which is held in each resident’s room. A complaints record was also held. Trafford Council’s Protection of Adults from Abuse Policy was not readily available at the time of inspection. The manager subsequently indicated, in writing, that the home does have this information. However, it needed to be a working tool that all staff could locate with ease. A requirement was made to the effect that this policy must be readily available to all staff and that all staff must be familiar with its contents. Bickham House DS0000005598.V251217.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 and 26 The environment is homely and attractive and meets residents’ needs. Overall, the home was clean, but some aspects of kitchen hygiene had the potential to put residents at risk. EVIDENCE: The home is attractive and comfortable and residents expressed their satisfaction with it. At the time of inspection, the maintenance contractor was completing repairs to some doors. The duty manager stated that 2 weeks prior to the inspection an extractor canopy had been fitted in the kitchen. The walls and ledges in the kitchen were covered in plaster dust and debris and walls, floors, ledges and the fridge were in need of deep cleaning. An immediate requirement was made accordingly and the manager responded to this soon after the inspection confirming that the work had been arranged. Bickham House DS0000005598.V251217.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 Staffing levels at the time of inspection were meeting residents’ needs and residents were happy with the staff. EVIDENCE: Residents, a resident’s friend and a resident’s financial advisor all said that the staff at the home were very good and did meet residents’ needs. The staffing rota for week ending 16/09/05 demonstrated that the home met the recommended minimum guidelines set by the previous registration authority, Trafford Metropolitan Borough Council. The inspector spoke to a visiting NVQ Assessor who said that she was always made welcome at the home when she visits every 4- 6 weeks. Staff training was not specifically assessed and will be assessed during the next inspection. Bickham House DS0000005598.V251217.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): 35 and 38 Overall, the arrangements for supporting residents to manage their finances was appropriate. The safety of residents and staff could be compromised by not undertaking the full range of fire safety tests and the fire risk assessment not being readily available as a working tool for staff. EVIDENCE: The home was holding some money for safekeeping for most of the residents. The duty manager stated that in most cases, residents’ families, friends, or in 2 cases a financial advisor, supported residents to manage their finances. A requirement made at the previous inspection to the effect that individual sheets must be used for financial transactions made on behalf of each resident had been addresses. However, a further requirement was made to the effect that individual receipts are held for transactions for each resident and an
Bickham House DS0000005598.V251217.R01.S.doc Version 5.0 Page 18 individual record of valuables kept for safekeeping on behalf of each resident is held. A requirement made at the previous inspection to the effect that hot water temperatures must not exceed 43 ° C had been addressed by fitting valves and monitoring temperatures. At the time of inspection, the duty manager stated that the emergency lighting had been found to be insufficient and the home was about to install additional emergency lighting. At the time of the visit, the home was not undertaking and recording checks of the means of escape and emergency lighting and the duty manager was unable to locate the fire risk assessment. A requirement was made to the effect that the advice of the fire department must be sought on the completion of a fire risk assessment for the home. Fire safety checks must be consistently undertaken of the means of escape and emergency lighting and the outcomes recorded in the fire log book. Bickham House DS0000005598.V251217.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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 2 X X 2 Bickham House DS0000005598.V251217.R01.S.doc Version 5.0 Page 20 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 2 Standard OP3 OP7 Regulation 14 13 Requirement Information from the needs assessments must inform, and be linked with, the care plan. Risk assessments must be reviewed to include all risks applicable to an individual resident, including the risk of falls. Risk assessments and care plans should be reviewed on a monthly basis When the dose of a resident’s medication is changed the bubble pack must be returned to the pharmacist for the amendment to be made. The residents’ GPs approval must be sought, in writing, to administer homely remedies. In addition, a care plan for the administration of medication, including when required” (PRN) medication, which confirms why medication is prescribed and in what circumstances and for what conditions, PRN medication is given must be in place for each resident. Timescale for action 30/10/05 30/10/05 3 4 OP7 OP9 13 and 15 13 30/10/05 30/10/05 5 OP9 13 30/10/05 Bickham House DS0000005598.V251217.R01.S.doc Version 5.0 Page 21 6 OP18 13 7 OP26 16 8 OP35 25 1 OP38 23 Trafford Council’s Protection of Adults from Abuse Policy must be readily available to all staff as a working tool and all staff must be familiar with its contents. The walls, floors, ledges and fridges in the kitchen must be subject to deep cleaning to remove loose plaster, food debris etc. Individual receipts must be held for transactions for each resident and an individual record of valuables kept for safekeeping must be held for each resident The advice of the fire department must be sought on the completion of a fire risk assessment for the home. Fire safety checks must be consistently undertaken of the means of escape and emergency lighting and the outcomes recorded in the fire log book. 30/10/05 22/09/05 30/10/05 22/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bickham House DS0000005598.V251217.R01.S.doc Version 5.0 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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