CARE HOMES FOR OLDER PEOPLE
Bide A While 14 Brick Kiln Road Old Town Stevenage Hertfordshire SG1 2NH Lead Inspector
Patricia Rogan Unannounced Inspection 13th March 2007 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bide A While DS0000019292.V333801.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. Bide A While DS0000019292.V333801.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Bide A While Address 14 Brick Kiln Road Old Town Stevenage Hertfordshire SG1 2NH 01438 220500 01438 360493 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) Mrs Pamela Pickup Mr Alan Pickup Mrs Pamela Pickup Care Home 3 Category(ies) of Dementia - over 65 years of age (3), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (3), Old age, not falling within any other category (3) Bide A While DS0000019292.V333801.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th December 2005 Brief Description of the Service: Bide A While is registered to provide care and support for up to three service users over the age of 65 years. This large, two storey detached house is situated in a quiet cul-de-sac close to the Old Town of Stevenage. There is a spacious lounge/dining/activity area which looks out onto the garden and patio. On some weekdays, this area is shared with day centre visitors. Residents also have their own, smaller lounge / dining room, if they prefer this. A large domestic kitchen is at the front of the house. A stair lift enables service users to have access to the bedrooms on the first floor. Two of the bedrooms have a toilet, wash hand basin and a shower and the remaining bedroom has a toilet and a wash hand basin. There are a two further toilets and an assisted bathroom. The garden is well maintained with a patio, seating and shaded areas. Fees range from £650 to £750 and are set out in the Service User Guide, which can be obtained from the manager and is available for all prospective residents. Fees for additional services such as hairdressing and chiropody are listed in the individual service contract. Bide A While DS0000019292.V333801.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced inspection of the key standards. Time was spent speaking with service users, staff and visitors to Bide A While in order to gather views about the way that care is provided on a daily basis. The care plans, risk assessments, daily records and other relevant information were examined and discussed with the manager. A tour was made of the premises and some of the record keeping including staff training, health and safety and rotas were inspected. A subsequent visit was made to Bide A While, providing the opportunity to meet with the proprietor and to give feedback regarding the inspection. This was a positive inspection and the quality outcome of this service was good. What the service does well: What has improved since the last inspection?
Each care plan is being reviewed to include a more comprehensive description of individual service user needs and social history. The requirements outstanding from the previous inspection have now been addressed: An induction programme has been devised and implemented for all staff.
Bide A While DS0000019292.V333801.R01.S.doc Version 5.2 Page 6 All staff have training in fire drills and the alarms are tested. Smoking is no longer allowed inside the premises at any time. Smoking is permitted in the garden. The staff training programme is being developed and will include person centred dementia care and Adult Protection procedures. A recruitment audit trail is being set up to ensure there are no gaps in staff recruitment and staff records. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bide A While DS0000019292.V333801.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bide A While DS0000019292.V333801.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. (Standard 6 is not relevant to this service) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have a care needs assessment and are involved in this assessment. EVIDENCE: An inspection of the records showed that the service users were assessed prior to moving into the home. Two residents said they had prior experience of short stays at Bide A While and made the choice to become permanent residents when the opportunity arose. One resident said, Before I moved in, I was given time to talk about what I wanted and now that I live here, I think the staff have done very well in looking after me. Bide A While DS0000019292.V333801.R01.S.doc Version 5.2 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans are being reviewed to provide more comprehensive information. All service users have full access to health care. The medication policy is good. Service users felt they were treated with courtesy and respect. EVIDENCE: The care plans are being reviewed and updated to provide comprehensive, individualised information as needs change. The service users are registered with a GP and have access to health care at all times. There is a policy for dealing with medicines and only staff trained in medication administration are allowed to do so. The policy includes the procedures for enabling service users to take responsibility for their own medication. The service users and their families felt that staff treated them with respect at all times. One service user commented that the staff always knocked and waited before entering the bedroom and were always polite.
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The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are enabled to experience a lifestyle, which reflects their interests and needs. Contact with family and friends and the wider community is encouraged. Services users are helped to make choices about what they would like to do. The diet is varied and nutritious and dietary needs are met. EVIDENCE: Two service users had enjoyed their previous stays in Bide A While and made the choice to become permanent residents because they knew the service met their expectations. All three service users appeared relaxed and happy sharing some of their time with the day centre visitors. One service user said she looked forward to the variety of the day times and the cosiness of the smaller lounge in the evenings. Visits from friends and families are encouraged. The menu is planned according to the season and is regularly changed to add variety and a choice is offered. There are two dining areas, both are pleasant and homely. Bide A While DS0000019292.V333801.R01.S.doc Version 5.2 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their representatives are confident that if they had a complaint, they would be listened to and that staff would try to resolve this. There are policies in place to protect the service users and arrangements are in place to ensure all staff have training in Adult Protection procedures. EVIDENCE: The service users said they had not had reason to make a complaint but felt sure that they would be listened to if they had a problem and that the manager would resolve matters satisfactorily. The staff were aware of the rights of the service users and were familiar with the whistle blowing policy. However, a recommendation was made following each of the two previous inspections that all staff should receive training in Adult Protection. The manager is arranging for all staff to have this training. Bide A While DS0000019292.V333801.R01.S.doc Version 5.2 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises appear to be generally well maintained. A more in depth, regular audit of the premises would ensure minor repairs are carried out in a timely fashion. The manager is implementing this. All areas of the home were found to be clean and pleasant. Soft paper towels and liquid soap for staff hand washing is required in order to help control cross infection in line with Department of Health Infection Control Guidelines. EVIDENCE: The home is in good decorative order and there are policies regarding maintenance of the premises. During the inspection, two toilet seats were found to be slightly loose and could have caused an accident. These had not been reported to the manager. A regular in depth audit of the environment
Bide A While DS0000019292.V333801.R01.S.doc Version 5.2 Page 13 and staff taking responsibility for reporting repairs when they are needed would help to minimise risks to service users. Bide A While was found to be clean and pleasant throughout. All areas were well ventilated and at a comfortable temperature. Soft paper towels and liquid soap for staff hand washing before and after providing care for each resident was not available and therefore the Department of Health Infection Control guidance was not being followed. Bide A While DS0000019292.V333801.R01.S.doc Version 5.2 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was sufficient staff on duty. Staff have mandatory training. Accredited training in person centred dementia care would ensure all staff have the appropriate skills to meet the changing needs of service users with dementia. Work is ongoing to ensure that recruitment policies and procedures meet regulatory requirements in order to ensure that service users are safeguarded. EVIDENCE: The rota showed that the numbers of staff on duty met the needs of the service users. There is a live-in member of staff on duty at night with staff cover in her absence. All staff have the mandatory training. The manager is preparing a schedule to ensure that training is up to date. The service is registered to provide care and support for people with dementia. Accredited training in person centred care for all staff would ensure that they have the specialist skills to support service users with dementia. In one or two cases, not all the recruitment procedures had been followed. The manager has established an audit trail to ensure these omissions do not occur.
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The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager is not on site but is in close proximity and in telephone contact at all times. The registered manager visits regularly each week to support the full time manager in the home. Efficient systems are in place for managing service users finances. The manager was pro-active and responded immediately to address issues such as infection control, staff training, auditing premises for repairs, recruitment procedures and reporting of incidents. EVIDENCE: Bide A While DS0000019292.V333801.R01.S.doc Version 5.2 Page 16 The unregistered manager on duty is experienced in the care field. Service users, staff and visitors to the home expressed satisfaction with the managers approach, describing her as friendly, helpful and supportive. The manager said the registered manager lives locally and visits Bide A While three times a week and either the registered manager or the proprietor are always available on the telephone. Health and safety issues in the home are given high priority and are generally properly managed. However more robust procedures for ensuring up to date guidance is followed regarding infection control, recruitment methods, specialist staff training and regular auditing the premises for any repairs needed would enhance the safety and well being of service users. Incidents and accidents which have happened in the home had been recorded but notification had not been forwarded to the Commission for Social Care Inspection. The manager and proprietor said that the care home had not accommodated service users for several months and had only re-opened at the end of last year. CSCI did not receive written notification of the temporary suspension or re-instatement of the service in accordance with regulatory guidance. Bide A While DS0000019292.V333801.R01.S.doc Version 5.2 Page 17 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 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Bide A While DS0000019292.V333801.R01.S.doc Version 5.2 Page 18 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP26 Regulation 13(3) Requirement Timescale for action 01/06/07 2. OP38 37 In accordance with Department of Health and the Health Protection Agency guidance, soft paper towels in holders and liquid soaps in dispenser must be provided by wash hand basins so that staff can wash their hands before and after assisting each service user. The registered manager must 01/05/07 ensure that all notifiable events as listed under Regulation 37 of the care Homes Regulations 2001 are reported to the Commission and confirmed in writing without delay. 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 OP19 Good Practice Recommendations A system should be developed which ensures staff report faults or breakages so that these can be remedied in a timely manner.
DS0000019292.V333801.R01.S.doc Version 5.2 Page 19 Bide A While Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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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