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Inspection on 13/12/07 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 13th December 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.

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

What has improved since the last inspection?

Mrs. Suzanne Marsh, who has managed the home since 2005, has now been registered with the Commission as a fit person to manage the home who fully understands her duties and responsibilities. There has been some refurbishment and redecoration within the home and new equipment has been provided, such as specialist beds and mattresses. Previous requirements to improve the standard of care planning, investigation of complaints and improve understanding of challenging behaviour have been met.

What the care home could do better:

Neither people who use the service, their family or staff feel there are sufficient care and nursing staff available at the home. Shortfalls are being met through the use of agency staff and, although consistency is sought, it is less likely than when a home`s own staff are available. Incidents of aggression between people at the home are attributed to this `lack of staff`. Family representatives state that they can spend `long periods of time` in the Moorland View Unit, especially the lounge, and see no staff. Staff mention difficulties caused by low staffing numbers, especially at meal times.Medicines are generally well managed at the home but further measures must be taken to fully comply with the home`s own procedures and current legislation. Necessary equipment must be available to promote independence and safe assistance with moving people whose mobility is poor. To this end the organisation needs to speed up its processes or make alternative arrangements.

CARE HOMES FOR OLDER PEOPLE Bickleigh Down Care Home Woolwell Road Woolwell Plymouth Devon PL6 7JW Lead Inspector Anita Sutcliffe Unannounced Inspection 13:30 13 December 2007 th 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 Bickleigh Down Care Home DS0000003574.V343175.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. Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bickleigh Down Care Home Address Woolwell Road Woolwell Plymouth Devon PL6 7JW 01752 695555 01752 696406 bickleigh.down@fshc.co.uk www.fshc.co.uk Four Seasons (DFK) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Suzanne Eloise Marsh Care Home 64 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) Category(ies) of Dementia (32), Mental disorder, excluding registration, with number learning disability or dementia (32), Old age, of places not falling within any other category (15), Physical disability (40) Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) - maximum 15 places Mental disorder, excluding learning disability or dementia (Code MD maximum 32 places Physical disability (Code PD) - maximum 40 places Dementia (Code DE) - maximum 32 places The maximum number of service users who may be accommodated is 64. 27th July 2006 2. Date of last inspection Brief Description of the Service: Bickleigh Down is a 64 bedded, purpose built care home with nursing. It is part of a large national Independent Health Care organisation, Four Seasons Health Care Limited. It is in the suburb of Woolwell, a few miles from the city of Plymouth and close to Dartmoor National Park. The home is divided into three units laid out on two floors. On the ground floor there is an eight bedded residential care unit for older people, and a twenty four bedded unit, called Moorland View, providing nursing care to older people with mental illness or dementia. On the first floor there is a general nursing unit for up to thirty people. There are a range of disabled bathrooms and toilets in the building. The organisation chooses to provide all single room accommodation at this time although four rooms can be used as doubles. There is a shaft lift between each floor and a range of communal spaces in each unit used for lounge and dining purposes. There is outdoor garden space available for people’s use and close to the home is a small shopping complex with a hairdresser, general store and a medical centre. A superstore is one mile away. A Registered Nurse manages the home and there is a registered nurse on duty Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 5 in each of the nursing units 24 hours a day. Current fees range from £287 - £739 a week. There is an additional charge for chiropody, hairdressing, personal items, telephone calls and entrance to activity venues. The most recent inspection report, the Statement of Purpose and Service User’s Guide are displayed in the entrance to the home. Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection included two unannounced visits to Bickleigh Down. Surveys were sent to people who use the service, their families and staff. Very few were returned. The registered manager sent us current information about the home. For the first visit we spent two hours in the Moorland View unit observing the care being given by staff. For the second visit we were accompanied by a Help the Aged representative working as an ‘Expert by Experience’. He spent three hours talking with people in the residential and nursing units, also sharing lunch. The Regional Lead Pharmacist Inspector also accompanied us and he looked at how the home handles medicines. Their findings are found within this report. We toured much of the home seeing lounge and dining rooms, laundry, kitchen and several bedrooms. We spoke with six care and nursing staff, the administrator, activities coordinator, catering manager and maintenance person. We also spoke with family of people who use the service. The registered manager and all staff were helpful throughout the inspection. We looked at some care records, policies and procedures. People who use the service may be described within this report as residents, clients or service users. What the service does well: There is a keenness within the home to achieve a high standard of service for people who live there. Staff said they were proud of the home and all were keen to demonstrate their achievements. People using the service like the staff and feel they do a good job. Comments include: “Staff work really hard” and “Staff marvellous”. The home is well run by a manager who has good insight into how care should be delivered and independence promoted for people in her care. She is keen to look at how improvements can be made. Assessment of people’s needs is thorough. Care is planned and regularly reviewed so that changes are identified be met. All aspects of the person’s needs were properly considered and staff are skilled and knowledgeable in their work. Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 7 Recruitment is undertaken diligently. The suitability of the applicant if fully considered and the manager ensures the person would be safe to work with vulnerable adults. The laundry service received special praise from people and many said how much they enjoyed the food. The home environment offers good variety of spaces and pleasant easily accessible gardens. The home is clean and hygiene well managed so that people live in a pleasant place and are protected from cross infection. People are protected from abuse and complaints are properly handled. People’s opinion is sought and the organisation has good systems for ensuring that the quality of the service provided meets their standards. Family of people at the home said: • “The staff couldn’t be more caring and understanding of the needs of patients. I feel they are all like family to myself and my husband”. • “Caring team, good medical attention, personal attention and a clean and tidy environment”. • “I rate this home highly for their dedicated and experienced staff”. What has improved since the last inspection? What they could do better: Neither people who use the service, their family or staff feel there are sufficient care and nursing staff available at the home. Shortfalls are being met through the use of agency staff and, although consistency is sought, it is less likely than when a home’s own staff are available. Incidents of aggression between people at the home are attributed to this ‘lack of staff’. Family representatives state that they can spend ‘long periods of time’ in the Moorland View Unit, especially the lounge, and see no staff. Staff mention difficulties caused by low staffing numbers, especially at meal times. Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 8 Medicines are generally well managed at the home but further measures must be taken to fully comply with the home’s own procedures and current legislation. Necessary equipment must be available to promote independence and safe assistance with moving people whose mobility is poor. To this end the organisation needs to speed up its processes or make alternative arrangements. 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. Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 9 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 Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 10 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 & 4 (Standard 6 does not apply to Bickleigh Down Care Home) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are properly assessed prior to admission to the home and those needs are generally well met. EVIDENCE: Three of the four people who replied to surveys said they had enough information about the home before moving in. The last inspection report, and written literature about the home are on display near the signing in book at the entrance. The registered manager says people are always invited to spend a day at the home before moving in. One person, having visited many homes in his past, said he knew Bickleigh Down well and chose it because “he knew it was best”. Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 11 We spoke with a person who has recently been admitted to Bickleigh Down nursing unit but they were unable to provide us with information about their admission. The registered manager had assessed her needs prior to admission and it appeared to be a true reflection of what we observed. It also included, amongst other information, assessment of diet and nutrition, ability to move safely and emotional and mental health needs. The information provided ensured that care could be appropriately planned. People have the opportunity to be involved in their assessment. There is a monthly review of those assessed needs. The home contains a specialist unit called Moorland View, where older people who have either a mental disorder or dementia reside. They are unable to maintain their own safety, needing close supervision and care. Many are fully mobile and so benefit from the layout of the unit, which provides good opportunity for those who like to wander. This also includes an easily accessible garden space. The manager understands how adapting the décor can help or hinder people’s ability to find their way around their environment. Some adaptation is already in place in the unit but there is more which could be done. There have been three complaints/concerns brought to the attention of the Commission regarding the unit since October and so we spent time observing what happened in the lounge/dining room and the care being given by staff. Staff came in for periods of time and the trained nurse and a new member of staff spent all her time there. It was clear that the quality of staff input had a strong impact on people’s wellbeing. One woman, sitting alone for the first hour, became very unhappy and eventually became tearful. Staff responded, dealing with her distress in a caring way. Two people sat passively unless staff made the effort to engage with them. Almost all staff interactions were a positive contribution to the person’s welfare. Without that interaction those people appeared isolated and were alone. Staff were friendly and, during the time we were there, in sufficient numbers to meet people’s needs. However, family of people in the unit report that there have been times when there have been no staff in the lounge/dining room for long periods of time. (Also see Standard 27). At those times people are unsupervised and vulnerable. The unit has had a history of poor management affecting outcomes for people living there. The registered manager says it is now better monitored by herself and has employed a trained nurse, starting in January, to ensure it is run in the best interests of people there. Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 12 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. The health and personal care that people receive is based on their individual needs and delivered in a professional and respectful way. EVIDENCE: Two people who responded to surveys said they receive the medical support they need and two said they usually do, one adding: ””I am well cared for in this respect by the staff”. There was good evidence that trained staff ensure all nursing needs are properly met and additional advice is sought as necessary, for example from wound care specialists. Staff said they are given very good information about the people they care for and those spoken with were able to talk about how they meet people’s particular and individual needs in the way preferred by them. Family of people using the service said that what the home does best is: “A caring team, good medical attention and personal attention”. Another said: “The staff couldn’t be Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 13 more caring and understanding of the needs of patients. Several family raised the concern that the local doctor surgery have stopped doing ‘home visits’ to Bickleigh Down. The registered manager has made arrangements to meet with them to discuss how people will be able to receive the service that is necessary and proper for them. We looked at the care records for two people at the home and found they provided a comprehensive overview of people’s health care needs. They were regularly reviewed with any changes noted and acted upon. Those examined appeared to be a true representation of what we saw and heard. People to whom they referred were unable to provide confirmation of this because of their level of disability. The registered manager says that care plans are well structured and supported by assessments and all staff deliver care in a professional and caring way maintaining dignity and choice at all times. We feel this is true. We found that most medicines are stored safely although we found in two areas of the home that whilst the cupboards comply with the current regulations the manner in which these cupboards are fixed to the wall does not. We observed that medicines are given to people safely and that the records are made after the administration has taken place. We did however find that for those people prescribed medicines with a variable dose that whilst a record was made to indicate that they had been given some medicine the actual dose administered was not recorded. We also found in one area of the home that the application of creams was only recorded by a tick and as such did not indicate who had taken responsibility for carrying out this task. We found that for some products it was not possible to determine if they were still safe to use as they had not been dated either when opened or removed from the fridge and appropriate action was taken whilst we were there to obtain replacement supplies of these medicines. We found in one area of the home that people’s valuables were being stored in one of the medicines cupboards, which was not in accordance with the home’s procedure and could lead to increased access to the medicine storage area. This was addressed following discussion with the manager. Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. People are generally well supported to make choices and, within their capabilities, lead a fulfilled life. EVIDENCE: Two people who responded to surveys said there was always activities arranged at the home that they can take part in, one said there usually was and one said never. Daily events are posted on a large whiteboard in a corridor and an attractive printed programme of events for December 2007 was available to all. This listed events such as, a Christmas Lunch Outing, visit from carol singing children from the neighbouring school, several parties/coffee mornings, Barber Shop Singers. The in-house activities organiser also presents a variety of events including bingo, skittles and bowling. One resident presents a “singsong” every week using his recorded music. Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 15 The local Vicar visits every month and takes a Communion Service. Attendance is said to be low. Some people received visits from members of their own church and so the option to follow individual faith is available. Several people take newspapers. The library books from Devon County Council Library Special Services are changed every three months providing variety. The home shares a vehicle alternate months with another home and this is used for trips to places like The Eden Project, Paignton Zoo, a Garden Centre and meals out. People make a contribution to the cost of these events. The home environment lends itself well to different activities through the variety of different lounges and spaces. There is a quiet lounge/library, a large dining area for big events and different, accessible, safe and pleasant garden areas, one with a new summer-house. Visitors are actively encouraged and welcomed. Residents said they choose when to retire and rise. One person said that, following a disturbed nights sleep, she greatly appreciated the carer allowing her to sleep on. We found the call bell alarm on the first floor is situated in a central area used as a small open plan lounge. The alarm is a noise, not conducive to calm, and it restricts conversation. (See Environment). There is a four weekly menu on display. Each afternoon all people are asked for their preferences for the next days’ breakfast, lunch and supper. There are always two choices of meals and the chef said that if this selection is not acceptable he will prepare anything else he has available to meet requests. Breakfast and Supper are taken in the bedrooms and Lunch generally in ground floor and first floor dining rooms. On the day of the second visit the choice of lunch was cottage pie or macaroni cheese followed by spotted dick and custard, or ice cream. We found the cottage pie was tasty and accompanied by carrots, Brussel Sprouts and scoops of creamed potatoes. The spotted dick was light. The meal was suitably hot having been brought up from the ground floor kitchen in, and served from, a heated trolley. Comments from People who use the service included: “Can’t fault the food”, “Good variety”, “Food very good”, “Always hot” and “Wholesome”. Where personal assistance with eating was needed, four carers in the first floor dining room gave it discreetly, at the same time conversing with the diner. People’s dietary intake is monitored so that concerns can be quickly identified and necessary steps taken. Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 16 Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 17 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. People who use the service are protected by the accessibility of the manager and the home’s policies and procedures. EVIDENCE: There has been one complaint/concern received by the Commission since the previous inspection. We referred the complaint back to the manager to investigate and then asked the complainant how well her complaint had been handled. She said: “Suzanne and the administrator have been wonderful; very accommodating. They’ve done everything I’ve asked”. There have been two incidences of aggression, reported to the Commission, between people who live in the Moorland View unit in the last three months. (Also see Choice of Home and Staffing). The registered manager had informed the Safeguarding team appropriately and taken proper steps to ensure people are safe in the home. She has also recruited a new nurse to manage the unit, who starts in January. Staff receive training both in how to protect people from abuse and dementia care management and understand what is expected of them. The four people who replied to surveys each said they knew who to speak to if they were not happy and they knew how to make a complaint. Family said Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 18 they knew how to complain one adding: “The matron is generally available. The door is always open and she provides sympathetic hearing”. Complaints made directly to the home have been properly dealt with and most family said the home responds appropriately to concerns raised about care. We looked at the complaints procedure and whistle blowing policy, which should inform staff what actions to take if they have concerns. Both gave clear information and were openly available for staff and people at the home to use. The Staff Handbook clearly defines staff obligation to the welfare of people at the home. Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 19 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, 20, 22 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, mostly fresh, well maintained and offers a variety of pleasant areas and adaptations to lesson disability, but equipment is not always properly available to promote independence and protect staff. EVIDENCE: The ground floor accommodates the residential section of the home and the Moorland Unit, access to which is via a key pad intended to helps those who wander stay safe. The first floor is the nursing unit. All contain a good standard of furniture and fittings. All have level access. Most of the home is ‘homely’ but the Moorland unit lounge/dining room is a little stark and less inviting than the rest of the home. (Also see Standard 4). However, it contains comfortable settees and has access to a pleasant, secure and well tended garden. Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 20 We found, throughout the home, some rooms have a ‘safety gate’ in place to stop people just ‘wandering in’ to bedrooms. This had been part of a previous complaint to the Commission. We confirmed that this is only used with the person’s consent. People do also have the option to lock their bedroom door. Visually, the standard of cleanliness is very good. During visits we found some small pockets of odour. People commented: “Rooms are cleaned every day”, “Pleased with cleanliness”, “Cleanliness pretty good” and “Spotlessly clean”. The in-house laundry service was highly praised by all spoken with. Often items are returned the same day. Outer garments are never worn for more than two consecutive days before being laundered. Under garments are laundered every day. The manager reports that there has been complete redecoration and carpeting of the Moorland and nursing units and redecoration of the residential unit and that new furniture, specialist nursing beds and mattresses have been purchased. There is now a summer-house within the well kept gardens which are adapted for people with disability. Family of a person using the service said the home: “Provides a pleasant (but small) room with en suite facilities, a pleasant and tastefully decorated home, kept reasonably clean, and well kept gardens and areas outside the resident’s rooms, also good parking”. The manager said the home provides or accesses equipment to aid people’s independence and staff confirmed they have protective equipment and aids to move people safely. However, staff also report that a hoist, needed for regular use at the home, has not been working since the beginning of October. It is not acceptable for a necessary piece of equipment to be out of use for over two months, in which time both people using the service and staff are disadvantaged. In addition, staff are having to ‘swap about’ batteries between hoists. We also found that the call bell alarm, situated where people congregate on the nursing unit, was piercing, unpleasant and inhibited rest and conversation. Both people using the service and staff were affected, one saying: “It drives you to distraction”. Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. The robust and thorough approach to recruitment and training of staff is sometimes undermined by insufficient numbers, which affects outcomes for people using the service. EVIDENCE: Some people who use the service said that, on certain days, there were not enough staff but added, “Staff work really hard”, “Staff marvellous” and “Staff are wonderful”. Call bell response time was said to be good, but frequently the responding carer having established the need, would explain that they were dealing with someone else and would return shortly. Several of those spoken with indicated that they would like to have more frequent showers (or in some instances prefer baths) but, being aware that the staff were “hard pushed”, had not made this request. Staff comments included: “I’m very proud of the home but the staffing levels are too low”. One said: When staffing levels were very low on an occasion “I didn’t know who I’d fed and who I hadn’t fed”. Another said: “Due to lots of staff shortages we cannot always provide the care and support we want”. Meal times were especially highlighted as difficult. Three staff spoken with, asked to Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 22 score ‘staffing’ out of ten (1 being worse and 10 best), said: “At its best 6 and at its worst 4”. Specific concerns have been raised regarding staffing levels in the Moorland View unit where, since the previous key inspection, there have been two incidents of aggression between people using the service who have dementia. Their family felt this was due to lack of supervision in the unit adding: “Awfully short staffed some of the time. Worse at week ends”. However, one of them now feels “Generally much happier with the home”. Staff said through survey that they had checks prior to employment to ensure they were safe to work with vulnerable adults. The registered manager described the difficulties of keeping potential employees interested whilst the pre employment checks are carried out. However, she ensures that staff have been properly recruited and is commended for ensuring their aptness for the work they are to do. When she is aware staff numbers will be insufficient she will use staff from a staffing agency. This has been a frequent occurrence. Four Season’s Health Care provide guidelines for how many staff there should be and each person who uses the service has their needs regularly reassessed so there is a way of seeing if their need has increased. Although needs are generally met the issue to staffing is clearly affecting outcomes for people and has the potential to be a risk. Staff felt their training was satisfactory and confirmed that all necessary training, such as fire safety and moving and handling, is done regularly. Staff in Moor Landland View unit attend training in dementia care, all staff receive training in how to protect vulnerable adults from abuse and a trained nurse confirmed she was up to date with wound care management. Family of people using the service felt that staff have the skills and knowledge to do their work adding: “Carers are always backed up by trained nurses”. However, the home has a low number of care staff who have achieved the National Vocational Qualification (NVQ) Level 2 in care, which is an indicator of staff competence. This should be addressed. Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 23 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 good. This judgement has been made using available evidence including a visit to this service. The home is well managed in the best interest of people who use the service. EVIDENCE: The manager, Mrs. Suzanne Marsh, is a registered nurse who has acted as manager since August 2005. She was registered with the Commission April 2007 having been assessed as a fit person to manage the home. People who use the service, their family and staff speak highly of her. Comments include: “Support in this home for carers is excellent” and “The matron is generally available. The door is always open and she provides sympathetic hearing”. Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 24 She has staff to manage different aspects of the home, such as catering. She works is in the best interests of people who use the service as far as she is able within her remit within the organisation, Four Seasons Health Care. Four Seasons Health Care have systems for monitoring the service provided at the home and looking at how to improve. These include annual customer surveys, residents and relatives meetings and customer feedback leaflets. Mrs. Marsh makes sure staff receive regular supervision through meetings and one to one assessment and discussion. Staff training needs are identified and planned for. People who use the service have, as a minimum, a monthly reassessment of their needs. There is a monthly, unannounced visit to the home by a representative of the organisation to check the home is being run properly. Mrs. Marsh says the organisation’s representative is available for consultation when needed. However, one family of a person at the home is unhappy with Four Seasons Health Care saying they do not respond to correspondence she has sent to them. We find that the organisation needs to address concerns people have about staffing levels and the time taken to replace much needed equipment. Currently no people using the service are able to manage their own finances totally. We were told that, for the vast majority, there is a balance of money kept so that people will have money available to them. We saw this is kept securely with a record of all transactions that have occurred. The home employs a maintenance worker so that maintenance problems can be dealt with promptly. The home reports that equipment is tested and maintained to safe standards and we found nothing to dispute this. Staff received all required health and safety training. Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 25 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 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 3 3 X 2 X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 26 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(2) Requirement Timescale for action 17/02/08 2 OP9 13(2) 3 OP22 23(2) 4 OP27 18(1) Arrangements must be made to ensure that all medicines cupboards are fixed in accordance with the current regulations. Arrangements must be made to 17/02/08 ensure that the actual dose administered to people prescribed a variable dose is recorded so that people’s response to medication can be monitored. The home must not be left 31/12/07 without necessary equipment to help people move safely as without it their independence is reduced and there is risk to them and staff. Care and nursing staff must be 17/02/08 employed in sufficient numbers to ensure a consistently high level of care, support and supervision of people is possible. Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 27 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 OP28 Good Practice Recommendations There should be an increase in numbers of staff undertaking the National Vocational Qualification (NVQ) qualifications in care as an indicator or staff competence in their work. Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Bickleigh Down Care Home DS0000003574.V343175.R01.S.doc Version 5.2 Page 29 - 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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