CARE HOMES FOR OLDER PEOPLE
Bickleigh Down Care Home Woolwell Road Woolwell Plymouth Devon PL6 7JW Lead Inspector
Andrea East Unannounced Inspection 12:45 28th July and 5 August 2008
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.V366770.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.V366770.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) Manager 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.V366770.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. 13th December 2007 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. Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 Page 5 A Registered Nurse manages the home and there is a registered nurse on duty 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.V366770.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 1 star. This means the people who use this service experience adequate quality outcomes.
The inspection site visit was carried out over two days. On the second day a second inspector toured the building speaking with staff and the people living at the home. A range of documents including staff and individuals’ files, policies and procedures were examined. People were spoken to in the homes lounge and in private rooms and members of staff were also spoken with. The homes manager (not registered with the Commission) was present throughout the inspection and on the second day of the inspection a senior manager was present for feedback from the inspection findings. Feedback about the home was also received by post in survey questionnaires, in the homes Annual Quality Assurance Audit, and by the homes own quality assurance system. Other information was obtained about the home through minutes of safeguarding meetings and a thematic inspection carried out earlier this year. A thematic inspection is a short, focused inspection that looks in detail at a specific theme. This thematic inspection looked at how well this service makes sure people are protected from abuse. We looked at whether this service has good procedures and training for safeguarding; how they work with other organisations to make sure people are safe; how they recognise abuse and respond to allegations to protect the people who use their service. We call these ‘safeguarding systems’ Information was also received through formal complaints about the home. What the service does well:
Medication administration systems, on the whole, were good. Medication was stored safely and administered by staff who knew the medication policy and procedures well. People enjoyed a varied choice of meals, snacks and drinks, at times that suited them. The people using the service praised the quality of the meals provided and said that they were pleased with the level of choice of menu on offer.
Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 Page 7 There was a detailed complaints procedure, which was clearly recorded and showed that concerns and complaints were taken seriously and addressed. Complaints were responded to appropriately, responding to individual concerns after investigation. The home had acknowledged some shortfalls in care in these complaints and had taken action to ensure that these concerns were addressed. Most of the home appeared to be clean, tidy and comfortable. The lounge and dining areas in the main part of the home, presented as pleasant, welcoming areas, which included individual rooms that 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?
Care plans and assessment documents had been reviewed and improved. Newly introduced individualised plans, included the use of “doll therapy” and was more focused on peoples individual preferences and choices. The manager and a new head of unit for the “dementia unit” described many new ideas to promote more individualised care for people living in this part of the home. This included a range of information and guidance from health professionals and specialists, which had been initiated by the safeguarding team to support the home. Other items newly introduced into the home to support people in participating in activities included an activity diary and newsletter, full of forthcoming events such as coffee mornings, chair aerobics and a art workshop. An invitation for everyone living at the home and their families or advocates to be part of the “activity committee” and notice boards kept up to date with information about the home. The thematic inspection highlighted several areas that the home had now addressed this included improved training for staff in safeguarding people from abuse, and clarity and review of the use of forms of restraints (stair guards in doorways, the use of bed rails). Recording of the use of equipment such as bed rails and stair gates had also improved. Staff training and supervision had improved and included staff training on safeguarding people from abuse. For example, a new induction for staff and a general awareness training session had been carried out for all staff in the home, regarding potential abuse issues. Good staff recruitment and selection procedures were in place. For example, staff files included completed application forms, interview notes, proof of
Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 Page 8 identity, reference and police checks. Staff files also held details of staff induction into the home, staff supervision and any disciplinary action the home had taken. These records demonstrated the homes commitment to ensuring that only those suitable to work with vulnerable adults were employed in the home. What they could do better:
The information on the use of restraints such as stair gates and the purchasing of large pieces of specialist equipment such as reclining chairs had not been detailed enough in the service users guide, so that people were unaware that these things may be in use. People need to be aware of what potential restrictions are in place and the arrangements for smoking in the home. This should be made clear before people come into the home. Care plans and assessments fluctuated in the information provided to care staff, some were fully completed while others needed to be more detailed. This will ensure that all staff will have accurate up to date information on how to meet people’s needs and care for people safely. The use of prescribed creams could be improved. One bedroom had six different types of creams in the room, the creams were not clearly labelled and two were prescribed for someone other than the person whose room it was. In other rooms creams were found to be unlabelled and out of date. Storing and using creams in this way may result in the wrong creams being used for someone who the cream is not prescribed for. This could result in breakdown of skin, infection and a lack of healing. People’s experiences of living in the home varied. So that some people were clear that the home met their needs, treated them as individuals and supported them in making choices and pursuing interests. While others were less clear. Everyone living in the home should be supported in pursuing interests and in making choices, including participating in life in the home or community. This should be consistently recorded in Care plans and assessments focusing on individual needs and preferences. The unit known as the “dementia unit” environment must be made more welcoming, homely and clean. The garden areas should be maintained so that people can enjoy going outside. The numbers of staff employed in the home had been raised as a concern in complaints received about the home and in discussion with the people living at the home.
Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 Page 9 The numbers of staff employed in the home should be continually reviewed and the numbers of staff employed in the home should be sufficient to meet peoples’ ongoing needs. Complaints also highlighted concerns that some staff appeared to have limited understanding of spoken English. So that were not clear about what people were saying and so did not know what peoples needs were or how to meet them. Staff should be conversant in the English language, so that they can understand peoples’ needs and preferences. The manager should be registered with the Commission. This will ensure that the manager is recognised as fit to manage the home and to meet a legislative requirement. The manager and senior manager had detailed action plans that identified areas that were to be addressed to improve the quality of care provided. They should continue to work through the action plan and address ongoing and new care issues. 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.V366770.R01.S.doc Version 5.2 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.V366770.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The people using the service were confidant that their care needs had been assessed and that their needs could be met, right from the start of their stay in the home. The services provided did not include intermediate care. EVIDENCE: Four files holding a range of information were examined. Files held preadmission assessments on peoples, needs, preferences and details of how people wished to be cared for. People said that they had been offered the opportunity to visit the home before moving into the home on a more permanent basis. Relatives also said that they had visited the home prior to their relative coming into the home. Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 Page 12 The 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 information on the use of restraints such as stair gates and the arrangements for smoking in the home had not been detailed enough in the service users guide. People need to be aware of what potential restrictions are in place and the arrangements for smoking in the home. This should be made clear before people come into the home. Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People using the service had their health, personal and social care needs met and this was set out in an individualised plan of care. People were involved in decisions about their lives, and played a role in planning the care and support they received. People were treated with dignity and respect and their privacy was upheld EVIDENCE: The home is divided into three units that are staffed and operated separately, with similar but not identical processes. The units are known as “the nursing unit” “the dementia unit” and the “residential unit”. Some staff worked across the nursing and residential units. Care in each unit can vary and since the last inspection changes in staffing and management arrangements had resulted in fluctuating standards of care across the units. A number of complaints regarding care and meeting people’s
Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 Page 14 needs had been raised with the home (see complaints). Safeguarding concerns in relation to care were also raised with the home resulting in placements in “the dementia unit” being suspended. Care placements in the nursing and residential units continued. Four files, including a range of information, on peoples needs were examined. Care plans and assessments fluctuated in the information provided to care staff, some were fully completed while others needed to be more detailed. Some Care Plans and assessments were completed and included information focused on people’s needs and preferences. The assessment process included asking people what name they wished to be called by and what routines they wanted to continue with: for example what time people wanted to get up and what time they wanted to go to bed. Assessments also included medical histories, personal safety issues, including any history of falls and any mental health concerns or considerations. People said that they felt well cared for by staff and that they were asked about how they wished to be cared for. Ongoing daily records such as diaries, communication books, reviews of care plans and daily evaluations showed consideration to peoples changing needs. Records also included information on health professionals visits. Surveys returned to the Commission from relatives, service users and staff indicated that recent staff changes and the loss of staff had been impacting on the care people received. For example two surveys from the people said “the call bells are not answered quickly enough”, and “I wish they had more staff they don’t have time to talk and listen.” (please also see staffing section) Complaints raised by families also raised concerns about the numbers of staff on duty being low and affecting care. People said that the care in the home was “good” and but “sometimes people are rushed”. Medication administration systems, on the whole, were good. Medication was stored safely and administered by staff who knew the medication policy and procedures well. People said that staff dealt with their medication safely and reliably. Medication records examined were well maintained. Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 Page 15 The use of prescribed creams could be improved. One bedroom had six different types of creams in the room, the creams were not clearly labelled and two were prescribed for someone other than the person whose room it was. In other rooms creams were found to be unlabelled and out of date. Storing and using creams in this way may result in the wrong creams being used for someone who the cream is not prescribed for. This could result in breakdown of skin, infection and a lack of healing. Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People’ s lifestyle in the home did not always meet their expectations or satisfied their needs. Some People who used the services were able to make some choices about their life style, and were supported to develop their life skills. Social, educational, cultural and recreational activities met some individual’s expectations. People enjoyed a varied diet in pleasant surroundings, with considerate support from staff. EVIDENCE: People’s experiences of living in the home varied. So that some people were very clear that the home met their needs, treated them as individuals and supported them in making choices and pursuing interests. This was not always so clear for those people with more complex needs or show’s communication was limited.
Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 Page 17 Care plans and assessments were not consistently focused on individual needs and preferences and did not make clear how people were supported in making choices, or participating in life in the home or community. The manager and senior manager said that the periods of time since the previous manager and some key staff (an administrator and a deputy manager) had left the home had been particularly difficult. The priority had been to focus on maintaining a good level of basic care. So that recreational activities and more person centred planning and care had been more slowly introduced than intended. Newly introduced individualised plans, included the use of “doll therapy” and was more focused on peoples individual preferences and choices. The manager and a new head of unit for the “dementia unit” described many new ideas to promote more individualised care for people living in this part of the home. This included a range of information and guidance from health professionals and specialists, which had been initiated by the safeguarding team to support the home. The complaints received by the home also highlighted a lack of attention to meeting individual specific needs and choices. The manager and senior manager had made changes to address those concerns. A range of documents including risk assessments, care plans and ongoing daily records showed how some people using the service were encouraged to maintain links outside of the home and with families and friends. Other items newly introduced into the home to support people in participating in activities included an activity diary and newsletter, full of forthcoming events such as coffee mornings, chair aerobics and a art workshop. An invitation for everyone living at the home and their families or advocates to be part of the “activity committee” and notice boards kept up to date with information about the home. The people using the service praised the quality of the meals provided and said that they were pleased with the level of choice of menu on offer. Lunch was served as the main meal of the day. Staff said that there was always a choice of menu and people were welcome to have visitors join them for lunch. Menu boards detailed what was on the menu for the day and staff reminded people what was for lunch throughout the morning. Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who used the service were able to express their concerns, and complaints and suggestions from those using the service, relatives or other visitors to the home were treated seriously. People were protected from abuse, and had their rights protected. EVIDENCE: Since the last inspection a thematic inspection had taken place at the home. A thematic inspection is a short, focused inspection that looks in detail at a specific theme. This thematic inspection looked at how well this service makes sure people are protected from abuse. We looked at whether this service has good procedures and training for safeguarding; how works with other organisations to make sure people are safe; how they recognise abuse and respond to allegations to protect the people who use their service. We call these ‘safeguarding systems’. The thematic inspection highlighted several areas that the home had now addressed this included improved training for staff and clarity and review of the use of forms of restraints (stair guards in doorways, the use of bed rails). Recording of the use of equipment such as bed rails and stair gates had also improved.
Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 Page 19 The people using the service said that they felt able to talk to all the staff including the manager about any concerns issues or worries. There was a format for writing down formal complaints, which included recording the outcome of the complaint and how it was resolved. There was also a compliments folder that held letters and cards from relatives and friends thanking staff for the care given. Cards and letters were also displayed on notice boards. Staff records showed that care staff had received training in issues relating to the protection of vulnerable adults. The manager said that the new induction for staff and a general awareness training session had been carried out for all staff in the home, regarding potential abuse issues. A record of complaints and compliments was also copied to the homes head office and monitored by the manager and senior manager. This included regular written breakdowns of risks and how to address risks. Since the last inspection there had been five complaints reported to the Commission either through the home or directly through social care professionals or concerned relatives. Some of the concerns raised were also part of the safeguarding process, which resulted in placements being halted in the “dementia unit”, part of the home. The home had responded to the complaints appropriately, responding to individual concerns after investigation. The home had acknowledged some shortfalls in care in these complaints and had taken action to ensure that these concerns were addressed. The homes manager and staff team had also addressed concerns highlighted by the health protection agency after the home had asked them to audit the premises. This shows the managers commitment to trying to improve practice and safeguarding individuals. Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People over all lived in a well -maintained house, which was clean and safe. One part of the home was not as homely or as well maintained as the rest of the building and the garden areas could be improved. EVIDENCE: On touring the premises most of the home appeared to be clean, tidy and comfortable. The lounge and dining areas in the main part of the home, presented as pleasant, welcoming areas, that the people using the service were observed enjoying, as they were using these areas to socialise in. People were chatting in one of the lounge areas with staff and the other people living at the home. Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 Page 21 In addition there was a pleasant library area with seating, for people to use as a quiet area. On the nursing unit the open corridor also has an area of seating that has sofa’s and chairs that are positioned outside the nurses office. Staff said that this was to make sure that any one who needed additional support could be more easily observed. The unit known as the “dementia unit” was markedly different in appearance to the rest of the home. The conservatory area in this unit was sparsely furnished And the flooring was ‘sticky’ when walked on. Staff said that they were trying different cleaning fluids to address this. This unit was not as personalised or as homely and people could not use the enclosed garden as it was so unkempt. The newly ‘head of unit’ for this unit, described planned new improvements for this environment. The manager and senior manager said that they were aware of the changes needed to improve this unit. The manager said that she had reviewed and updated a range of information for staff in policies and procedures, including health and safety and risk assessments for the premises. Most areas of the home including peoples’ individual rooms had been personalised with items of furniture, photographs and ornaments. Surveys returned to the Commission said that the home was always clean and fresh. Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The people using the service, were supported by Staff, who were trained, skilled and competent. Staff had been subject to rigorous recruitment checks. Sometimes the numbers of staff employed in the home and the high turn over of staff affected peoples’ care EVIDENCE: The manager, senior staff and care staff said that the home continued to support staff to complete a range of training based on the needs of the people using the service. This included training in key areas such as infection control, health and safety and first aid. Staff training records and supervision records for staff showed that staff had completed internal and external training. This included staff completing National Vocational Training in Care at level two or above. Staff training completed since April 2008 included infection control, wound dressing and dementia care. The manager said that further training for staff was planned in key areas such as manual handling updates and updating in first aid training.
Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 Page 23 The manager said that a range of internal training had taken place. This was in response to report highlighting safeguarding issues and a lack of training for staff in this area. The manager had purchased information packs on safeguarding people as part of the internal training for staff. A sample of staff files were examined and they included completed application forms, interview notes, proof of identity, reference and police checks. Staff files also held details of staff induction into the home, staff supervision and any disciplinary action the home had taken. These records demonstrated the homes commitment to ensuring that only those suitable to work with vulnerable adults were employed in the home. Complaints received by the Commission through relatives, social care workers and through the safeguarding process highlighted concerns at the numbers of staff employed in the home. The complaints highlighted low staff numbers affecting the quality of care provided. The manager said that since the last manager had left the home, several key staff had also left the home. This included a deputy manager, who was also the head of the ‘dementia unit’, an administrator and some care staff. This had resulted in a period of time were staff were supported with agency staff and were covering shifts, while recruitment took place. The senior manager said that in investigating the complaints the numbers of staff on duty were adequate. Staff rosters showed fluctuating numbers of staff on duty. Other concerns related to staffing, was the lack of understanding of basic English language for some staff employed in the home. The complainants said that they thought staff were not fully aware of how best to care for people as they had not understood what was being said. Surveys from staff, relatives and the people using the service expressed concern at the high turn over of staff resulting sometimes in the use of agency staff and low numbers of staff. People living at the home raised concerns about the shortage of staff, the high turnover of staff and how this sometimes affected their care. For example they said “waiting for care is longer than it should be” and “because of a shortage of staff I have to wait for care”. People living at the home said that the shortage of staff did not always affect them and that overall they felt well cared for. However they were concerned that should the situation continue there care needs would not be met. Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 Page 24 The manager said that she was in the process of recruiting more staff and had highlighted the staffing issues with senior management. Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People lived in a adequately managed home, with the management, and staff team, working together to provide a safe environment that was run in the best interests of the people who live there. EVIDENCE: The manager registered with the Commission left the home earlier this year. The current manager is not registered with the Commission. The manager had a range of training and skills and was supported by a senior manager, a newly appointed administrator and a newly appointed deputy manger, to assist in the day- to -day running of the home.
Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 Page 26 The manager and senior manager had detailed action plans that identified areas that were to be addressed to improve the quality of care provided. They had begun work in several areas to address issues highlighted through complaints, including staff training and recruitment of new staff. Records required to be kept on the management of the home and the care people received were completed, reviewed and updated. This included risk assessments for the premises and for individuals’ specific needs. Staff training and a staff induction programme, was carried out on a routine regular basis, so that staff were aware of peoples needs and how to care for them. The manager and staff team had implemented a range of quality assurance systems including asking the people living at the home their views. 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. Good record keeping systems were in place to safeguard people’s finances and these records were audited. Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 Page 27 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 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x x x x x 3 Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 Page 28 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 2 Refer to Standard OP1 OP7 Good Practice Recommendations The service users guide needs to be updated to include information of what potential restrictions are in place and the arrangements for smoking in the home. Care plans and assessments should be extended and consistently completed, so that all staff will have accurate up to date information on how to meet people’s needs and care for people safely. The use of prescribed creams should be reviewed and polices and procedures improved so that creams are only used as prescribed. People’s choices and preferences including their choice of routine and activities should be clearly recorded. The unit known as the “dementia unit” environment must be made more welcoming, homely and clean The garden areas should be maintained so that people can
DS0000003574.V366770.R01.S.doc Version 5.2 Page 29 3 4 5 6 OP9 OP12 OP19 OP19 Bickleigh Down Care Home 7 OP27 8 9 10 OP27 OP31 OP33 enjoy going outside. The numbers of staff employed in the home should be continually reviewed and the numbers of staff employed in the home should be sufficient to meet peoples’ ongoing needs. Staff should be conversant in the English language, so that they can understand peoples’ needs and preferences. The manager should be registered with the Commission. This will ensure that the manager is recognised as fit to manage the home and to meet a legislative requirement. The manager and senior manager had detailed action plans that identified areas that were to be addressed to improve the quality of care provided. They should continue to work through the action plan and address ongoing and new care issues. Bickleigh Down Care Home DS0000003574.V366770.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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
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