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Inspection on 10/05/05 for Bickleigh Down Care Home

Also see our care home review for Bickleigh Down Care Home for more information

This inspection was carried out on 10th May 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service has improved its staff relationships internally resulting in an improvement in moral that has had led to the clients giving positive feedback about the care they receive. The documentation is in a corporate format that does provide consistent and well-constructed record keeping arrangements throughout the home. A recent tutorial has improved care planning and subsequently other record keeping. The clients and one relative reported an improvement in the overall service.

What has improved since the last inspection?

Staffing levels in the general nursing unit have improved and clients report an improvement in the care and attention that they receive. Several staff reported an improvement in the moral among staff since the present Manager has got to grips with the management of the home. Levels of staff training in appropriate subjects such as Adult Protection has increased with a clear plan for future training for all grades of staff.

What the care home could do better:

The elderly mentally ill unit has a large communal area that is not of an ideal design for this client group as all activities occur in this open design area. Some sensible screening would allow separation between the lounge and dining/activities area. An area that offers less stimulation for clients who are agitated would also be beneficial to the clients. The stability now experienced needs to be consolidated with the recruitment of the Registered Manager particularly given the change of ownership of the organisation.

CARE HOMES FOR OLDER PEOPLE Bickleigh Down Care Centre Woolwell Road Woolwell Plymouth PL6 7JW Lead Inspector Douglas Endean Announced 10 May 2005 th 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 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. Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bickleigh Down Care Centre Address Woolwell Road, Woolwell, Plymouth, Devon, PL6 7JW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01752 695555 01752 696406 BetterCare Group Limited Care Home 64 Category(ies) of Dementia - over 65 years of age (32), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (32), Old age, not falling within any other category (15), Physical disability over 65 years of age (40), Terminally ill over 65 years of age (4) Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1.Care for Three Named Service Users under 65 with significant nursing needs. 2. One named Service User requiring Nursing Care under the age of 60 years Date of last inspection Brief Description of the Service: Bickleigh Down is a 64 bedded purpose built care home with nursing and is part of a national organisation. It is in the suburb of Woolwell, a few miles from the city of Plymouth and close to the Dartmoor National Park. It is divided into three units laid out on two floors, one 8 beded residential care unit for the elderly, one 24 bedded unit dedicated to provide nursing to the elderly mentally ill including Alzheimers and Dementia suffers, and a general nursing unit that has 30 beds. There are a range of disabled bathrooms and toilets in the building and the establishement has also a number of different types of hoists available to meet the assessed needs of the clients. The organisation chooses to provide all single room accommodation at this time but 4 rooms can be used as double rooms with the agreement of the clients who would be asked to share. The home is Managed by an experienced dual qualified registered nurse and a registered nurse is always on duty in each of the nursing units. There is a shaft lift between each floor and a range of communal space for dining and lounge space in each unit. The gardens were being tended during this inspection having become overgrown. Close to the home is a small shopping complex with a hair dressers, general store and a medical centre. A superstore is just one mile away and can be reached by bus. The Registered Managers post is presently vacant but the home is being managed by a very compotent nurse manager at this time. Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by the new inspector of this service and was conducted over two days. The home has undergone a period of difficulties in the recent past that has resulted in some staff and management changes. This inspection has shown how the changes, such as increased staffing levels and good leadership from an experienced manager, has benefited the care provided and the moral of the staff employed at this home. The inspector spoke to seven clients and two relatives to obtain there views on subjects covered in this report. He read a sample of six clients files and four staff files that were matched against the recruitment procedure and training files. What the service does well: What has improved since the last inspection? What they could do better: The elderly mentally ill unit has a large communal area that is not of an ideal design for this client group as all activities occur in this open design area. Some sensible screening would allow separation between the lounge and dining/activities area. An area that offers less stimulation for clients who are agitated would also be beneficial to the clients. The stability now experienced needs to be consolidated with the recruitment of the Registered Manager particularly given the change of ownership of the organisation. Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 Page 6 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. Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 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 standard(s) 3; 6 does not apply. Bickleigh Down is designed and equipped as a suitable environment for the delivery of personal and nursing care. The staff are trained to provide the differing levels of care required by the clients. EVIDENCE: Each of the six clients records, selected at random from across the three areas of the home, had copies of a completed “Bettercare Pre Admission and Assessment form”. The forms were completed by a registered nurse who is named on the form as having completed the assessment. The forms held a level of information that enabled the Manager to make an informed decision about the suitability of each admission. (A copy of the form has been obtained for the Commission for Social Care Inspection file). The completed forms that were seen hold information about the activities of daily living, behaviour, daily nursing needs and other specialist care needs. Bickleigh Down is a purpose built establishment that has been designed and equipped as a care home that can provide nursing. The tour of the building and its facilities provided visual evidence of its suitability for the purpose stated. The staff employed at the home are either trained nurses or Social Care staff who have received training in providing personal care. Staff personnel files and Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 Page 9 the Managers training matrix provided the inspector with evidence of suitable training having taken place. Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 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 standard(s) 7,8,9 and 10. The documentation held on clients is well constructed and informative and provides a platform for care to be delivered to the clients in an effective way. The staff provide the care in a respectful and dignified way. EVIDENCE: Each of the six sets of clients records that were seen have in them a completed care plan that has been reviewed at least each month. The care plans seen each follow a set format that covers the assessed areas of need identified by the pre-admission and continued assessments including personal, social and nursing care for each individual client. There are Registered General and Psychiatric nurses employed at the home to meet the nursing needs of the clients who receive nursing care. The duty rosters seen, and also provided for inspection, show that a registered nurse is on duty in each of the nursing units over the 24-hour day. The staff personnel files and pin number audit record shows that each nurse is currently registered with the Nurses and Midwifery Council. The six client records provided evidence that it is normal practice to register clients with a General Practitioner. One client in the residential unit was in receipt of nursing care delivered by the District Nurse and her records were along side the homes own care records. Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 Page 11 The Manager has arrangements in place for the clients to be attended to by other health care professionals such as the Occupational Therapist, Physiotherapist and Chiropodist, etc, at the home. The home was seen to provide wholesome food in a form that suited the clients assessed needs as stated in their nutrition assessment. The homes arrangements for managing medication in each unit was inspected and found to be satisfactory. Only registered nurses and care staff who have been trained, administer medication. Evidence of care staff medication administration training was seen. Medication administration sheets were seen to hold procurement, administration and disposal information. The inspector spoke to seven clients during the tour of the home. Each client felt that they were treated with dignity and respect although one client did comment on the attitude of one staff member. There was visual evidence of care being provided in a respectful and dignified way as staff who were involved in feeding clients were seen to do this in a unhurried way. One relative praised the care his mother receives at the home. Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 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 standard(s) 12,13, 14 and 15. The arrangements made to meet the social and domestic needs of the clients is effective. EVIDENCE: The clients are able to receive visitors at any reasonable time. The inspector saw several clients receive visitors during the inspection. One visitor was involved in providing care to his relative. The clients are able to have their own telephone lines if they wish to maintain contact with friends and the wider community. Telephones were seen in some of the bedrooms during the tour of the home. Bedrooms were personalised through the use of possessions brought to the home by the clients themselves. There is a full time activities co-ordinator who plans a wide variety of events throughout the three units. Evidence was provided of the one to one and group activities that have occurred in the home this year such as shopping excursions, reminiscence, music therapy, hairdressing etc. The co-ordinator was not working at the time the inspection took place. The seven clients spoken and the remarks in three client comment cards received by the Commission for Social Care Inspection say the meals that they choose to have are well presented and satisfy their needs. Meals were seen to Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 Page 13 be provided in a number of ways depending upon the clients assessed needs and abilities. Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 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 standard(s) 16 and 18 The homes recruitment procedures are robust and to allow only suitable candidates to be employed. The complaints procedure is clear for anyone to follow if they have a complaint or concern that they wish to be addressed. EVIDENCE: The complaints procedure was seen on display in the main entrance and also in the Statement of Purpose that was read during the inspection. The complaints register was looked at during the inspection. It held details of complaints received and the manner in which the Manager has addressed them. The Plymouth City Council document “Protection of Vulnerable Adults, Alerter Guide” was seen to be on display in the main entrance area and in several clients rooms during the tour of the home. The staff-training matrix was looked at and it provided information on the number and identity of staff that have now completed the Protection of Vulnerable Adults training. There is a staff recruitment procedure that was seen during the inspection. The sample of four staff files that were read during the inspection held the level of information required by the recruitment procedure and the Care Homes Regulations 2001, Schedule 2. Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 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 standard(s) 19, 22, 24 and 26. There is adequate communal space in each unit but the elderly mentally ill space could be better designed to provide more suitable surroundings. The home is clean, well maintained and satisfactorily decorated and provides a safe environment for the clients to live in. EVIDENCE: The establishment is a purpose built care home that was intended to provide general and psychiatric nursing to older people. The tour of the home provided visual evidence that it is suitably designed and equip for its purpose. There is a shaft lift between floors, disabled toilets and bathing facilities, wide corridors and a nurse call system throughout the building. There was evidence provided that showed that competent persons have serviced the equipment at suitable intervals. There is a full time maintenance man employed at the home who was met during the inspection. The client’s rooms each had a nurse call bell system in place and bell cords available to each client. Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 Page 16 Rooms were furnished according to the client’s wishes and the risk assessments for each client held in their own files as seen in the sample of files read during this inspection. Each of the three units have there own communal facilities for meals and activities that were in use for different purposes during the inspection. The communal area in the elderly mentally ill area of the home did not provide any physical separation between lounge, dining and activity space. During the tour of the home it was seen to be clean and tidy. The duty records show that there is approximately 120 hours of domestic time spread over the seven-day week. The establishment has its own fully equip laundry and full time staff dedicated to this area only. Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30. There are sufficient numbers trained nurses and care staff to meet the diverse needs of the clients resident at the home. EVIDENCE: The Manager employs staff in such numbers and experience to meet the assessed needs of the clients. The staff duty sheets provided as part of the pre inspection information show the numbers of staff and how they are deployed each shift. Three of the seven clients spoken said that recent improvements in the staffing levels have resulted in them feeling that their needs are being met in a timely way. Each unit is staffed separately from each other and the nursing units have a registered nurse in charge at all times. There is a recruitment procedure that was read during the inspection. The four staff files that were read were constructed as directed by the recruitment procedure and as required by the Care Homes Regulations 2001, Schedule 2. The audit system provided evidence that files are reviewed to establish that they hold the information required of them. Staff training records, Criminal Records Bureau checks, references and Nurses and Midwifery Council ‘PIN’ checks were among the documents seen in the sample of staff files that were read during the inspection. The four staff records, and Managers training file, that was seen during the inspection, also provided written evidence of the induction and foundation training undertaken by the staff with addition induction training for overseas staff. Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 Page 18 The training matrix showed that 41 of the current staff group have a National Vocational Qualification in care. The Person in Charge of the elderly mentally ill unit provided evidence of the “National Certificate in Dementia Care “ course that she is to commence in October 2005. Evidence was seen that showed staff in the elderly mentally ill unit has had training in dementia and challenging behaviour. Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35, 36 and 38. The Acting manager provides effective leadership for the staff that has raised moral and improved the care of the client’s. The attention to maintenance and the environment has provided a safe place to live and work in. EVIDENCE: The Registered Person employs a Risk Manager, Complaints and Contracts Manager, Training Manager, Human Resources Manager and a Regional Administrator external to the establishment to monitor its performance. Each audit their area of responsibility and some records were seen during the inspection that verified this happens. There is Quality Assurance policies and procedures to establish and measure performance against. The home has a Manager who has demonstrated her qualities in management and leadership during this inspection. The staff spoken to were very complimentary about her skills, the level of support they have received and her Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 Page 20 personality. She is not the Registered Manager for the home and the post remains vacant. The Manager has provided evidence as to how she has proportioned out the task of staff supervision between the two heads of care. Supervision has commenced and the annual plan on display in the Managers office gives clear evidence as to how it is intended to progress this year. The Manager provided evidence of training, maintenance and repair during the course of the inspection as evidence that the health safety and welfare of the staff and clients are continually monitored and met. The inspector’s tour of the home and comments received in writing and verbally from clients and their relatives suggests that the above comment is correct. The home does not manage the affairs of any client and do not act as appointee for any client. The clients have relatives, solicitors and guardians to manage their affairs and this is recorded in their personal files. Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x 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 x COMPLAINTS AND PROTECTION 3 x x 3 x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x 3 x 3 3 x 3 Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 Page 22 Yes Are there any outstanding requirements from the last inspection? 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 OP31 Regulation 8(1)(a)(b) (i) Requirement The pegistered provider shall appoint as individual to manage the care home where there is no registered manager in respect of the care home and the registered provider is an organisation or partnership. Timescale for action By the 1st September 2005. 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 Good Practice Recommendations Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Bickleigh Down Care Centre D54-D07 S3574 Bickleigh Down V215860 100505 Stage 4.doc Version 1.30 Page 24 - 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. 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