Inspection on 30/11/07 for Bickham House

This inspection was carried out on 30th November 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bickham House 12/01/06

Bickham House 20/09/05

Bickham House 20/09/05

Bickham House 14/12/04

Bickham House 08/07/04

Bickham House 23/03/04

Bickham House 01/12/03

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Bickham House Green Walk Bowdon Altrincham Cheshire WA14 2SN Lead Inspector Adele Berriman Unannounced Inspection 30th November 2007 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.V348481.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 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.V348481.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th January 2006 Brief Description of the Service: Bickham House is a large detached Victorian care home for older people. It operates as a registered charity. Mrs Cathrine Myers is the Registered Manager. Bickham House is situated in Bowdon. The home is close to local 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 older people in comfortable spacious surroundings. All bedrooms are single rooms and the residents enjoy the benefit of a large, accessible and well-maintained garden. The cost of the service is £435.00 per week for permanent residents and £450.00 per week for people receiving respite care. Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two visits were made to the home one on the 30th November 2007 and one on the 3rd December 2007. The visit on the 30th November was unannounced. The visits were undertaken as part of a key inspection in which all of the key standards for the National Minimum Standards for Older People are assessed. The inspection process includes analysis of all the information received about he home since its previous inspection and a survey forms available for residents and their relatives/friends to complete and give their views on the service provided at the home. Several surveys were completed by residents and their relatives. Prior to the visits taking place the manager of the service was requested to complete an Annual Quality Assurance Assessment (AQAA) about the service. This assessment required the manager of the service to document what the service does well, what the service could do better and how the service has improved in the last twelve months. The manager completed the assessment form in detail. During the course of the visits time was spent talking to the residents, the manager, members of care staff and the cook. Time was also spent assessing the policies and procedures of the home and examining records, and resident and staff files. During the visits the home had a very comfortable relaxed environment. All residents spoken to during the visits and who completed survey forms stated they always receive the care and support they needed and the majority of relatives who completed survey forms stated that the service always meets the needs of their relatives. The majority of relatives stated in their survey forms that the home always keeps them up to date with important issues relating to their relative. All residents spoken to and who completed a survey form stated that staff listen to them and act on what they say and that they receive the medical support they need. The majority stated that staff are always available when you need them. Residents spoke positively about the environment in which they live and the food served at mealtimes. Residents stated that they knew who to go to if they were not happy or wished to make a complaint. All of the relatives who completed a survey form stated that they knew how to make a complaint about the care provided by the home. Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 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 Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People’s needs and wishes are assessed prior to moving into the home to ensure that the service offered at Bickham House can fully meet the needs of individuals. EVIDENCE: Initial enquiries from or on behalf of prospective residents are documented on an ‘enquiry form.’ Following an enquiry the manager or a senior member of staff will visit the individual at their home or whilst they are in hospital to carry out an assessment of their needs and wishes to ensure that the service offered at Bickham House can fully meet needs and wishes. Perspective residents are encouraged to visit the home to meet with the residents and staff for a trial visit. A copy of the home’s Statement of Purpose and Function and the most recent inspection report from then Commission for Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 Page 9 Social Care Inspection were displayed in the foyer of the home to further inform people about the service. Residents spoken to during the visits to the home and information gained from survey forms demonstrated that people received enough information about the service prior to moving into the home. Bickham House does not provide intermediate care facilities. Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Regular review of care plans and risk assessments addressed the changing needs and wishes of residents. EVIDENCE: An individual care plan was available for all residents. These documents clearly demonstrated what activities individuals were able to carryout independently and any areas in which the resident needed support. Information contained in the care plans was detailed and informative and it was evident that all care plans were reviewed and updated on a monthly basis. Care plans contained individual risk assessments to consider identified risks to individuals. There was evidence that these risk assessments were reviewed on a regular basis. Each resident was registered with a local general practitioner and detailed records demonstrated that other healthcare professionals including district nurses, chiropodist, physiotherapist and dentist had visited the home to support the residents. All residents spoken to during the visits and who Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 Page 11 completed a survey form stated that they always received the medical support they needed. Records are maintained on a daily basis of what care and support had been offered/delivered to residents. The content of these records varied in detail as some records contained detailed information about the residents day, however some entries were limited for example, X ‘is fine today, nothing to report.’ The manager of the service produces a six monthly report on the wellbeing of individual residents which is made available to their relatives following consultation with the resident and with their consent. Policies and procedures for the management of medication were in place to protect residents. Only senior member of staff had the task of ordering and administering medication and a detailed recording system was in place. All medication is stored appropriately when not in use. When medication is being administered staff use an open trolley to transport the medication around the building. Discussion took place during the visit about the need for staff to be able to secure all mediation at all times in the event of an emergency. During the visit some prescribed creams were being stored in an areas that was accessible to all, these items were removed immediately and stored appropriately During the visits staff were observed at all times addressing and supporting residents in a manner that protected the individuals dignity and in a respectful manner. A private area with a telephone was available in the hallway and residents have the opportunity to have a private telephone installed in their room. Mailboxes were available for all residents in the hallway for their unopened post and newspapers to be collected from. All residents who completed a questionnaire form stated that staff listen to them and act on what they say. Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ social and cultural needs and wishes were considered in the home’s activity and social arrangements. Residents benefit from having a nutritious and varied menu. EVIDENCE: A programme of activities and entertainment is arranged at the home on a regular basis and the programme is displayed in board and also in the monthly newsletter. The programme demonstrated that entertainers regularly visit the home. Regular visits from local ministers and lay visitors ensure that resident’s wishes relating to their faith are supported. Residents confirmed to the inspector that they had the choice as to whether they attend the entertainment arranged at the home. All residents who completed a survey form and who were spoken to during the visits stated that there were always activities arranged to meet their needs to take part in. Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 Page 13 The home has an ‘open door’ visitor’s policy and relatives and friends are encouraged to visit at all times. Several relatives were seen visiting the service during the inspection visits. One relative was observed ‘booking in’ both herself and a member of her family to have lunch with their relative at the home on Christmas day. The manager confirmed that relatives were welcome to join in the festivities at all times. A varied menu was available for the residents. At the time of the visit the cook had made homemade biscuits for afternoon tea and supper. All residents had a nutritional plan that recorded resident’s likes and dislikes relating to food. The cook said that this information along with feedback from residents meetings was taken into account when considering new menus. It was the choice of most residents to have their breakfast in their rooms. A choice of porridge, cereals, fruit and toast was served in residents’ bedrooms on a tray. Choices were available for lunchtime and evening meals and the menu for the day was displayed in the dining room. Food served at the time of the visit looked appetising and were served in a large pleasantly furnished dining room where the tables were set with condiments. Fresh fruit was readily available for residents in the dining room. The home benefits from a vegetable garden which is tended by volunteers. All residents spoken to during the visit stated that they enjoyed the food served at the home and the majority of residents who completed a survey form stated that they always liked the meals at the home. Comments included “food very good”, “ find them not too heavy” and “I love the meals most of the time - sometimes I don’t like them but that’s not often at all.” Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures were in place to safeguard residents from harm. Residents and their relatives know how to make a complaint about the service. EVIDENCE: A copy of the home’s complaints procedure was readily available in the lobby of the home and a copy was available in each bedroom. A procedure was in place to record any complaints received by the home. The service had received one complaint since the previous inspection and records demonstrated that this complaint had been resolved to the satisfaction of the complainant. All residents spoken to during the visits and who completed a survey form stated that they knew who speak to if they were not happy or if they wished to make a complaint. Completed survey forms from relatives also stated that they were aware of how to make a complaint about the service and one relative wrote “I would tell matron but there is a strict policy on the complaints procedure.” Policies and procedures were available at the home to safeguard residents from harm. The service had a policy for the protection of vulnerable adults. The policy was informative, however, the policy stated that ‘the home may contact social services and the police.’ The policy needs to be reviewed so that Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 Page 15 it clearly states that Trafford Social Services need to be contacted at all times in the event of a potential or actual abusive situation taking place. A copy of Trafford Social Services joint agency adult protection procedures was available at the home along with other information from Action on Elder Abuse. The manager of the service stated that she had attended talks relating to safeguarding with the Trafford Care Consortium. Staff had received awareness training in adult protection by video and questionnaire. One referral had been made to Trafford Social Service under their joint agency adult protection procedures. This referral was under investigation at the time of this report. Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from having a homely, clean and pleasant environment in which to live. EVIDENCE: Bickham House is a large well maintained Victorian house with extensive accessible grounds. The home was very clean and fresh and communal areas of the home were comfortably furnished with furnishings that met the needs of the residents. Bedrooms were personalised and contained personal effects and cherished items of the residents. A programme of routine on going maintenance was in operation and since the previous inspection the home had had some electrical rewiring work, had upgraded the emergency lighting, new carpets and blinds had been fitted to some areas of the home, more grab rails have been added around the building and there is an on-going programme of re-decoration. Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 Page 17 During the visit residents spoke positively about the environment in which they lived. All residents spoken to and those who completed a survey form said that the home was always fresh and clean. Following a requirement from the previous inspection report safety bars had been fitted to all windows that were assessed as a potential risk to residents. Exposed hot water pipes had been lagged to reduce the risk from the hot surface temperature. A fire door on the first floor of the accommodation was not fully fitting into its recess. The manager of the service stated that this would be rectified within the next twenty-four hours. Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs and wishes are met by the staff team. EVIDENCE: The service had a recruitment procedure that ensured that an appropriately completed application form, relevant references and Criminal Records Bureau checks were gained prior to a person commencing employment. This procedure safeguards residents by ensuring that staff were suitable to work with vulnerable people. At the time of the visits a sufficient number of care and ancillary staff were on duty to meet the needs of the residents. All newly recruited staff received an induction into their role. A clear staffing structure and line of accountability was in place. During the visits observations were made of staff interacting with residents in a positive non-discriminatory manner and staff demonstrated a detailed knowledge of individual residents needs and wishes. Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 Page 19 Detailed records demonstrated that staff were provided with ‘in house’ training opportunities in many aspects of their role and over 50 of staff had achieved their NVQ award level two and several staff had achieved or were currently working towards their level three award. All volunteers working at the home are requested to undertake training for their role. All residents spoken to during the visit and those who completed a questionnaire stated that they receive the care and support they needed. One resident wrote “I always feel I can ask for help at any time” and another resident wrote ‘I think the care is very good and X who is my key worker is very good and helpful.’ All residents stated that staff were always available when they needed them. Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is managed in the best interest of the residents. EVIDENCE: The home is managed by a competent person who holds a professional nursing qualification, has achieved the registered managers award and has a certificate in management. During the visits to the home the manager demonstrated that she was experienced in managing a social care environment in an effective manner. This was demonstrated in the continual development of the services care planning and reviewing processes and an attention to detail to ensure the health, safety and wellbeing of all. Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 Page 21 During the visits the manager demonstrated strong leadership skills with the staff team with clear direct written and verbal communication taking place to promote good practice. The manager stated that she operated an ‘open door’ policy and during the visits to the service it was evident that residents, staff and visitors took the opportunity to speak to the manager whenever they wished. One relative stated “the care home have an open door policy to the office where I can go to voice concerns – these would be discussed with key worker/carers to reach a suitable solution to any problems.” Since the previous inspection a member of the board of trustees records the findings of their visits and gives a copy to the manager and sends a copy to the Commission. It is the home’s policy not to take responsibility for residents’ financial affairs. However, a small amount of money is held safely for some residents to pay for hairdressing, newspapers etc. Records are maintained of these transactions. A comprehensive quality assurance system was in place to gather the views of residents on the service provided at the home. Positive comments were received from residents during the visits about the management of the home. One resident wrote in their survey “I enjoy living here and most people would like it” and another resident stated “the home is well managed.” One residents relative stated “provides a comfortable atmosphere for residents and relatives with nothing too much trouble.” A detailed manual was available that contained policies and procedure to minimise any risk to health and safety. Policies and procedures were in place to offer guidance and support in their role. Maintenance records were available to demonstrate that regular testing of the hot water temperatures around the building, fire detection system etc and maintenance contracts were also in place to ensure the safe ‘running’ of the home. Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 Page 22 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement A system must be developed that enables medication to be secured at all times. All designated fire doors must fully close at all times to ensure the safety of all. Timescale for action 07/01/08 2. OP38 23 (4) 28/12/07 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 OP7 Good Practice Recommendations It is recommended that residents daily records contain detailed information about the activities and their experiences of the day. A system should be developed that ensures that medication is secure at all times to ensure the safety of residents and staff. It is recommended that the services adult protection policy is reviewed and updated to include full details of Trafford Social Services joint agency adult protection procedures. 2. OP9 3. OP18 Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Manchester Local Office 11th Floor Westpoint 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Bickham House DS0000005598.V348481.R01.S.doc Version 5.2 Page 25 - 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!