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Inspection on 24/11/09 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 24th November 2009.

CQC found this care home to be providing an Good service.

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

People said the meals were very good with plenty of choice as well as alternatives should someone change their mind from what they had previously ordered, or felt unwell and wanted a lighter meal. Drinks and snacks are available throughout the day and snack boxes were available for people in the dementia care unit whose appetite was poor and who found it difficult to eat a whole meal. Care plans had been reviewed and where necessary rewritten to ensure they provided a clear description of people’s needs. The information was found to be detailed and easy to find. Associated risk assessments were also held in the appropriate sections of the care plan for ease of use. Daily care notes were well written and provided a good description of the care given and how the person had spent their day. Medication administration systems were good. Medication was stored safely and administered by staff who knew the medication policy and procedures well. There was a detailed complaints procedure on display in the main hallway and in the Service User Guide. Concerns and complaints are taken seriously and records detailed the investigation and actions taken to resolve the matter. The home was found to be clean, tidy and comfortable, with no unpleasant odours. The lounge and dining areas presented as pleasant, welcoming areas and people’s bedrooms had been personalised with items of furniture, photographs and ornaments. Peoples’ finances and personal allowances were well managed by the home. People were supported to manage their own finances with support of relatives and outside advocates such as solicitors.

What has improved since the last inspection?

The random inspection in April 2009 noted the care plans were poorly completed and, as identified above, the care plans have been reviewed and where necessary rewritten. Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.2 Staff training and supervision continues to improve and a training matrix and programme for the forthcoming year demonstrated the home’s commitment to ensuing the staff receive the training necessary to care for people with dementia and those in very poor health. Training also included safeguarding vulnerable people from abuse. Good staff recruitment and selection procedures were in place. For example, all the staff files examined included a completed application forms, interview notes, proof of identity, two written reference and record of the police check. These records demonstrated the home’s commitment to ensuring that only those suitable to work with vulnerable adults were employed in the home. The courtyard garden accessible from the dementia unit has been tidied and provides a pleasant seating area.

What the care home could do better:

The newly appointed home manager and deputy manager have very clear ideas about how to improve the services provided in the home and have concentrated their efforts on improving the care plans and staff training and supervision to ensure people’s needs are recognised and met in a consistent manner. Five recommendations have been made as a result of this inspection. The Service User Guide should be updated to inform people of the arrangements should they wish to smoke: smoking is not permitted in the home but a shelter is provided in the garden. The Guide should also describe the arrangements for the security of the building and the availability of money being held for safekeeping either in the home’s safe or in a dedicated bank account specifically for the use of people living in the home. The pre-admission assessments should include all the information gained about a person’s care needs rather than a short overview description as this does not demonstrate the good practice within the home or allow a decision to be made about the suitability of the home. Also, people’s hobbies, interests and cultural and religious preferences should be recorded prior to their admission to ensure the home can prepare for their admission and offer them leisure activities that meet their needs and the support to continue to follow their religious beliefs. The home manager should discuss and review the use of the stair gates with the person, their family and their social worker to ensure everyone is in agreement with their safe use. The meal time arrangements in the dementia care unit should be reviewed to ensure people are helped more appropriately.Bickleigh Down Care HomeDS0000003574.V378606.R01.S.docVersion 5.2The numbers of staff employed in the home should be reviewed in light of the people’s dependency needs and be adjusted accordingly to ensure people’s needs are met safely and in a timely manner.

Key inspection report CARE HOMES FOR OLDER PEOPLE Bickleigh Down Care Home Woolwell Road Woolwell Plymouth Devon PL6 7JW Lead Inspector Jane Gurnell Key Unannounced Inspection 24th November 2009 09:30 DS0000003574.V378606.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Bickleigh Down Care Home DS0000003574.V378606.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) Post vacant 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.V378606.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. 28th July 2008 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 twentyfour 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. Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.2 Page 5 Registered Nurses are on duty in each of the nursing units 24 hours a day. Current fees range from £500 - £706 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.V378606.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was undertaken over a 3 day period: 24th November from 09:45 to 16:50 to review the personal care needs of the people living in the home and to speak to staff, 25th November from 09:45 to 13:05 to review staff recruitment, training and supervision as well health and safety arrangements and 3rd December at 3pm to meet with the home’s administrators to review how the home manages peoples finances. The deputy manager was available on the 1st and 2nd days and the home manager was available on the 2nd day and 3rd days. Both they and their staff team assisted us throughout the inspection and provided clear information about the home. During the inspection a tour of the building was made and many of the people living in the home were spoken with as well as the staff on duty and two visiting relatives. A range of documents were examined which included the care plans and assessments for 6 people living in the home, 3 staff recruitment and training files, the training programme for the forthcoming year, the fire log book detailing the servicing and testing of the fire alarm system and the records of people’s money held for safekeeping. Prior to the inspection, the home manager had completed an Annual Quality Assurance Assessment (AQAA) which details the services provided in the home, how the home meets people’s needs and what plans there are for further development. Also we sent surveys to 15 people living in the home and to 15 staff to enable them, anonymously if wished, to let us know their views of the home and the quality of the services provided. Seven surveys were returned by staff and two surveys were returned by people living in the home. The two people living in the home said that they felt well supported and staff listened and acted upon what they said. The staff surveys reflected the unsettled period the home has been through without a manager as well as some concerns over the staffing levels, but on the whole they were positive about the future development of the home: comments included good nursing home, staff are dedicated and new changes have been put in place along with the new manager which is made home a better place. On the first day of the inspection a two-hour period of direct observation of people living in the home and staff interaction was made using the Commission’s Short Observational Framework for Inspection tool (SOFI). This allows us to observe people’s well being, the relationship between them and the staff and the quality of this interaction, for example, whether the interaction from staff is task based or in social engagement. Staff were seen to Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.2 Page 7 interact very patiently and in a friendly manner with people, but at times it was felt there was not enough staff to support people, particularly at mealtimes and this is discussed in the relevant section of the report. This report also contains the results of a random inspection carried out in April 2009 as a result of concerns over the quality of care provided in the residential unit of the home. What the service does well: People said the meals were very good with plenty of choice as well as alternatives should someone change their mind from what they had previously ordered, or felt unwell and wanted a lighter meal. Drinks and snacks are available throughout the day and snack boxes were available for people in the dementia care unit whose appetite was poor and who found it difficult to eat a whole meal. Care plans had been reviewed and where necessary rewritten to ensure they provided a clear description of people’s needs. The information was found to be detailed and easy to find. Associated risk assessments were also held in the appropriate sections of the care plan for ease of use. Daily care notes were well written and provided a good description of the care given and how the person had spent their day. Medication administration systems were good. Medication was stored safely and administered by staff who knew the medication policy and procedures well. There was a detailed complaints procedure on display in the main hallway and in the Service User Guide. Concerns and complaints are taken seriously and records detailed the investigation and actions taken to resolve the matter. The home was found to be clean, tidy and comfortable, with no unpleasant odours. The lounge and dining areas presented as pleasant, welcoming areas and people’s bedrooms had been personalised with items of furniture, photographs and ornaments. Peoples’ finances and personal allowances were well managed by the home. People were supported to manage their own finances with support of relatives and outside advocates such as solicitors. What has improved since the last inspection? The random inspection in April 2009 noted the care plans were poorly completed and, as identified above, the care plans have been reviewed and where necessary rewritten. Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.2 Page 8 Staff training and supervision continues to improve and a training matrix and programme for the forthcoming year demonstrated the home’s commitment to ensuing the staff receive the training necessary to care for people with dementia and those in very poor health. Training also included safeguarding vulnerable people from abuse. Good staff recruitment and selection procedures were in place. For example, all the staff files examined included a completed application forms, interview notes, proof of identity, two written reference and record of the police check. These records demonstrated the home’s commitment to ensuring that only those suitable to work with vulnerable adults were employed in the home. The courtyard garden accessible from the dementia unit has been tidied and provides a pleasant seating area. What they could do better: The newly appointed home manager and deputy manager have very clear ideas about how to improve the services provided in the home and have concentrated their efforts on improving the care plans and staff training and supervision to ensure people’s needs are recognised and met in a consistent manner. Five recommendations have been made as a result of this inspection. The Service User Guide should be updated to inform people of the arrangements should they wish to smoke: smoking is not permitted in the home but a shelter is provided in the garden. The Guide should also describe the arrangements for the security of the building and the availability of money being held for safekeeping either in the home’s safe or in a dedicated bank account specifically for the use of people living in the home. The pre-admission assessments should include all the information gained about a person’s care needs rather than a short overview description as this does not demonstrate the good practice within the home or allow a decision to be made about the suitability of the home. Also, people’s hobbies, interests and cultural and religious preferences should be recorded prior to their admission to ensure the home can prepare for their admission and offer them leisure activities that meet their needs and the support to continue to follow their religious beliefs. The home manager should discuss and review the use of the stair gates with the person, their family and their social worker to ensure everyone is in agreement with their safe use. The meal time arrangements in the dementia care unit should be reviewed to ensure people are helped more appropriately. Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.2 Page 9 The numbers of staff employed in the home should be reviewed in light of the people’s dependency needs and be adjusted accordingly to ensure people’s needs are met safely and in a timely manner. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.3 Page 10 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.V378606.R01.S.doc Version 5.3 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, and 5. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving to Bickleigh Down and their relatives can be confidant that their care needs are assessed to enable the staff to decide upon the suitability of the home and to prepare for the person’s admission. EVIDENCE: The deputy manager described the arrangements for assessing someone considering moving to the home: she, the home manager or one of the nursing unit managers visits the person to provide them with information about the home and to undertake an initial assessment to ensure the home is able to meet their needs. People and their relatives are invited to visit the home to meet the staff and to make a choice of the available bedrooms. This was evident on the first and second day of the inspection when the deputy manager visited a lady in Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.3 Page 12 hospital and the following day when her relatives came to the home to look around and reserve a room. The home manager explained to them that they were free to visit at all times and to take a meal with their mother if they wished. She said they should treat the home as they would do if their mother was in her own home. Three pre-admission assessments were examined and two contained more detailed information than the third. The unit manager for the dementia care unit said they had recently reviewed the amount they recorded to a description of current and past medical history and also a “dependency” table. However the she was able to describe in detail the information she had obtained which was much more than was recorded. The home manager was advised to record all the information received to demonstrate the home’s good practice and the information used to decide on the suitability of the home. Relatives said that they had visited the home prior to their relative’s admission and were very satisfied with their choice. The home manager said that people were welcome to stay in the home on a probationary period, to ensure that they settled into the home and were happy with the services provided. People received information about the services provided, through informal discussion, a contract of ‘terms and conditions’ and the Service Users Guide. The Guide should be updated to include the arrangements for smoking as the home is a non-smoking environment, the availability of a bank account for people’s money and the security arrangements such as locked doors or doors with keypads. Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.3 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home had their health, personal and social care needs met in a respectful manner that protected their privacy and dignity. People were involved in decisions about their lives, and played a role in planning the care and support they received. EVIDENCE: Those people spoken with and who were able to comment directly about the care and support they receive said they felt well cared for. This was supported by the surveys returned to us prior to the inspection. People said the home was “lovely” and “very nice”. Those people unable to comment about the home due to their dementia or poor health appeared well groomed and comfortable. The care plans for six people were examined (two in each unit) and these were found to be clearly written providing guidance to staff on what the person could do for themselves and how staff should offer assistance in a safe and Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.3 Page 14 consistent manner. Risk assessments relating to diet and nutrition, mobility and the risk of falls, and skin care had been completed and highlighted additional areas of concern and the measures necessary to reduce the risk of deterioration in health. There was evidence that the care plans and assessments had been regularly reviewed and updated ensuring they provided a description of the person’s current needs. Daily care notes were detailed and provided a good description of the care the person had received and how they had spent their day. The home manager and deputy manager explained that they had developed good relationships with other health care professionals, such as the District Nurses (for people in the residential unit), GPs, Psychiatrists and the Community Mental Health Team, and Tissue Viability Nurses, who are available to offer specialist advice and support. Staff were knowledgeable about people’s care needs and were seen to interact with people in a respectful, caring and friendly manner. The SOFI helps us understand the experiences of people who are unable to tell us themselves and who are most likely to have the greatest care needs. It allows us to get an insight into the general state of well-being of individuals and staff interaction with people who use the service during the observation. The observations were undertaken in the dementia care unit and covered the lunchtime meal. Staff were seen to interact well with people in a caring, patient and friendly manner. People in the dementia care unit had significant mental and physical impairments due to their dementia and this unit had a keypad controlled entrance to ensure people do not leave the area unsupervised. Those people who preferred to keep active were seen to wander freely around the unit. One person who had been newly admitted to the home was provided with one-toone staffing until the staff were confident that he was safe to walk around the home unaided. Two people preferred to stay in their rooms and as they wished to keep their doors open had requested a stair-gate to be fitted across their doorway to prevent other people entering their rooms. The use of these gates was discussed at length as they can be misconstrued as keeping people in their rooms rather than keeping others out, and they could cause injury due to people trying to climb over them. The unit manager and home manager both gave assurances that the use of these gates was seen as a last resort to reassure these two people that no-one would enter their rooms uninvited; they said no one had tried to enter the rooms or climb over them. The home manager was asked to review the use of these gates with the person, their family and their social worker to ensure everyone was in agreement with their safe use and to document this review. Medicines, including controlled drugs, are stored safely in all three units. Senior care staff in the residential unit are provided with training to enable Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.3 Page 15 them to administer medicines safely: nurses administer the medicines in the two nursing units. Medication records were found to be neat and accurate. Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff and activity co-ordinators strive to provide interesting and stimulating leisure and social activities for all those living in the home regardless of disability or ill health. People enjoyed a varied diet in pleasant surroundings, with considerate support from staff. EVIDENCE: The home employs an activity co-ordinator each day of the week, Monday to Friday 9:30am to 4:30 pm. Two people currently share this role and both had previously worked as care staff and have an understanding of people’s needs. Activities such as painting, baking and exercises are provided in each unit and 1:1 activities are provided for people who either prefer to stay in their own rooms or who due to illness need to stay in their rooms. The activity coordinators keep a record of who has participated each day. People and their Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.3 Page 17 relatives are invited to suggest activities and trips out from the home: the home shares a minibus for outings with their sister home in Plympton. The activity co-ordinators are currently recording people’s life histories, hobbies and interests and religious beliefs onto their care plan to enable them to plan events to meet people’s interests and preferences. The dementia care unit had two “rummage” boxes with items of interest, such a musical instruments, games, cards and pictures for people to pick up and examine and to be used as a point of interest, engagement and conversation. The home has also introduced “doll therapy” for some people, as it has been recognised that people with dementia miss their caring role and the dolls provide comfort to those who are missing family and their children. These dolls are specifically designed for this purpose, are of a realistic weight to be carried as one would carry a baby, and people are able to keep them with them at all times if they wish. During the SOFI, one person was seen to be “caring” for her doll and was smiling and content. The home manager reported that both male and female residents responded well to the dolls. People living in the home praised the quality of the meals saying they were “very nice” and “good”. They said there was plenty of choice including at least three choices at lunchtime, and that portions were plentiful. People are asked the previous day for their choices but on the day should someone change their minds or prefer a lighter meal, alternatives were available and drinks and snacks were available throughout the day. The lunchtime meal was observed in the dementia unit of the first day of the inspection. The food was delivered to the unit in a heated trolley to ensure the meals were kept warm. The majority of people required some assistance with their meal, either prompting to eat themselves or to be fed their meal. Staff were seen to assist people sensitively and with patience. We felt however that even with all the staff and the unit manger assisting, six staff in total, there were too many people to help at any one time and staff were anxious that everyone had had the opportunity to eat well. The unit manager said she would consult with her staff about offering two sittings at meal times to ensure people could be assisted more appropriately. Some people found it difficult to stay at the table and preferred to wander from time to time whist eating their meal and staff allowed them to do this recognising that to repeatedly ask them to return to the table would cause distress: these people did eventually eat a full meal, dessert and have a hot and cold drink. Others were unable to use a knife and folk due to their level of disability but were able to eat well using their fingers and the unit manager was asked to ensure that where this is the case either food was prepared in the kitchen as finger food or the staff cut the meal into smaller pieces to ensure people could pick it up and eat it more easily. Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home and their relatives can be confident their concerns or complaints will be listened to, treated seriously and resolved as promptly as possible. People’s rights are protected and staff training and recruitment practices protect vulnerable people from abuse. EVIDENCE: People living in the home and the staff spoken with said they had confidence in the newly appointed manager and deputy to deal with any concerns: this was confirmed by the people living in the home who returned a survey. Resident and relative meetings allow people to raise general concerns and for the home manager to pass on information to people. An “open door” policy ensures people have access to the manager of they wish to speak to her in confidence. The home manager said that prior to her appointment not all concerns or complaints had been recorded but she had started a register to record issues brought to her attention. The register contained one complaint with records of the investigation carried out by the home manager and the action taken to resolve the matter. Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.3 Page 19 The random inspection in April this year was undertaken in response to concerns raised through the local authority about the care of people living in the residential unit, i.e. the unit for people who do not require nursing care. The inspection concluded that care plans did not contain sufficient detail regarding people’s needs nor were staff sufficiently well trained to recognise changing needs and when to involve the District Nurse. The home manager said that the care plans had been reviewed and rewritten where necessary and staff had been provided with more specific training. The home manager had also met with the District Nurse to ensure communication from the home improved. Discussion with staff and the examination of records indicated staff had received training in issues relating to the protection of vulnerable adults. The home manager said the new induction training programme for staff included this issue. Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Bickleigh Down is a spacious and comfortable home. It is well–maintained, clean and safe and has sufficient facilities to meet people’s needs. EVIDENCE: The home was found to be very clean, tidy and comfortable, with no offensive odours. Each unit has its own communal areas: the residential unit has a library/lounge room, dining room and conservatory, the dementia care unit has a large lounge/dining room with access to an enclosed garden as well as a conservatory, and the nursing care unit has a large lounge room and separate dining room. In addition the nursing unit has a seating area adjacent to the nurse’s station for those people who require a higher level of observation or who don’t wish to sit in the TV lounge. Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.3 Page 21 All areas of the home looked at were pleasantly decorated and in a good state of repair. People are encouraged to personalise their rooms with furniture, pictures and ornaments. The home manager described plans to further improve the dementia care unit with themed pictures in the dining room and pictures of Plymouth in years gone by in the hallways to provide points of interest for people. The home had large bathrooms in each unit with some baths fitted with spas as well as hoists for ease off use by people with restricted mobility. There are toilets close to communal areas for use during the day: all but 3 bedrooms have en suite toilet facilities. Window openings are restricted for safety purposes, radiators are covered to reduce the risk of burns should someone come into contact with them when they are on and hot water temperatures are controlled to reduce the risk of scalding. Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are competent and kind. Robust recruitment practices ensure as far as possible only suitable staff are employed. Staffing numbers and skill mix would benefit from review to ensure they relate to the dependency needs of the people living in the home. EVIDENCE: All the people spoken with, including two relatives and those who returned survey said they felt well cared for. They described the staff as “lovely”, “very kind” “really nice”. They said they were helped promptly whenever they rang their call bell but felt staff did not always have the time to sit and talk to them. There were 8 people living in the residential unit with one senior care staff on duty, 21 people in the dementia unit with 5 care staff and one nurse on duty, and in the nursing unit, there were 16 people with 3 care staff and one nurse. We had some concerns over the ability of the staff to meet people’s needs in a timely manner, for example on the first day of the inspection people in the nursing unit were receiving assistance with their personal care up until lunchtime and in one case not until after lunch. This was resolved on the second day of the inspection when an extra member of staff was provided for the nursing unit. The home manager has been asked to review the dependency levels of the people in the nursing unit to ensure people’s needs could be met Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.3 Page 23 in a timely manner. The home manager gave assurances that she would undertake a full review of the dependency needs of everyone in the home and ensure the staffing levels and the skill mix of staff was appropriate to meet their needs. The staff on duty were spoken with and all said they felt well supported and they worked well as a team. They said they were receiving training they needed. One staff member was new to the home and she said she was working alongside an experienced member of staff as part of her induction. Some concerns were raised over the numbers of staff available during the night on the dementia care unit and during the day on the nursing unit and these were passed on to the home manager. Seven staff returned a survey to us and all but two staff felt the home was improving with better opportunities for training. Both these two staff said they have not met with the manager and had some concerns over staffing levels. This was discussed with the home manager and deputy manager who both recognised that the home had gone through a very unsettled period. The deputy manager said she works alongside staff two full days a week and is available at all times on other days and the home manager has an “open door” policy for all staff and she intends to spend more time also working alongside the staff. Staff meetings have been reintroduced and the deputy manager and both nursing unit managers have received training in supervision practice to enable them to offer regular structured supervision for all the staff to address these issues. A training programme has been developed for the forthcoming year and records indicate that staff have received recent training in fire safety, dementia care, infection control, wound care, moving and handling and safeguarding vulnerable adults. The organisation has an in-house training department which has produced training booklets for all staff in subjects such as fire safety, infection control, safeguarding, food hygiene and death and bereavement to provide additional support with training. The home manager said staff were supported to undertake National Vocational Training in Care at level two or above but currently less than 50 have were qualified. This was an area she was keen to address through staff support and supervision. Three staff recruitment files were examined and these contained all the necessary pre-employment checks including a completed application forms, interview notes, proof of identity, two written references and police checks, ensuring as far as possible only suitable staff were employed. Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed in the best interest of people who use the service. EVIDENCE: The newly appointed manager is an experienced manager having been a manager at one of Four Seasons other care homes in the area. She was appointed as the permanent manager in September 2009 although she was providing management support to the home for a few months prior to this after the previous manager had left the home. She demonstrated a good understanding of the management needs of the home and the support required for the staff to provide high-quality care to people living in the home. She confirmed she was in the process of preparing her application to the Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.3 Page 25 commission to register, as this confirms the home is managed by a competent and skilled person. The manager is supported by a deputy manager who is a registered nurse as well as a nurse manager in each of the nursing units. Those people spoken with who were able to make a comment about the management of the home said the manager and deputy manager were very approachable and they had confidence in their abilities. Of the seven staff returning a survey of five said they are well supported by the manager, comments included Im very happy with the new manager she is very supportive and making changes for the better, she [the new manager] is doing a very good job. Shes very friendly, easy to talk to and she tries hard to sort things out and the new management structure works well. The home has a high morale since changes began. The two staff who felt less supported had concerns over the support of the night staff and the staffing levels at night in a dementia care unit as noted above. Four Seasons Health Care have systems for monitoring the service provided at the home and looking at how to improve. These include regular internal audits and visits by the regional manager, annual customer surveys, meetings with staff, residents and relatives, and customer feedback leaflets. The results of a recent internal audit made available and included a review of the arrangements made to manage peoples finances. The home manager said that staff supervision had not been undertaken since the previous manager had left home and this was something she and the deputy manager were very keen to reintroduce. The deputy manager and the two nursing unit managers had recently received training in supervision practices and had identified a supervision structure with the home. Staff training needs have also been reviewed and planned for. Currently none of the 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. For larger sums of money the home offers the use of a non-interest-bearing bank account. The records for this and the auditing process were made available and demonstrated a good level of security to peoples money. 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. Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.3 Page 26 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 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.3 Page 27 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. Standard Regulation Requirement Timescale for action 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 OP1 Good Practice Recommendations The Service User Guide should be updated to include information about the arrangements for smoking in the home, the availability of a bank account and the security arrangements in the home. The pre-admission assessments should include all the information gained about a person’s care needs. People’s hobbies, interests and cultural and religious preferences should be recorded prior to their admission to ensure the home can prepare for their admission and offer them leisure activities that meet their needs and the support to continue to follow their religious beliefs. The home manager should discuss and review the use of the stair gates with the person, their family and their social worker to ensure everyone was in agreement with their safe use. The meal time arrangements in the dementia care unit should be reviewed to ensure people are helped more appropriately. The staffing levels should be kept under review to ensure DS0000003574.V378606.R01.S.doc Version 5.3 Page 28 2 OP3 3 OP10 4 5 OP15 OP27 Bickleigh Down Care Home people’s needs can be met consistently and in a timely manner. Staffing levels should reflect the dependency of the people living in the home not just the numbers of people in the home. Bickleigh Down Care Home DS0000003574.V378606.R01.S.doc Version 5.3 Page 29 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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