Inspection on 17/10/05 for Bilton Court

This inspection was carried out on 17th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bilton Court 11/03/09

Bilton Court 25/02/08

Bilton Court 28/02/07

Bilton Court 20/09/06

Bilton Court 04/11/04

Bilton Court 19/05/04

Bilton Court 23/01/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bilton Court Windermere Drive Queensway Wellingborough Northants NN8 3FR Lead Inspector Mrs Kathy Jones Unannounced Inspection 10:30a 17 October 2005 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 Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 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. Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bilton Court Address Windermere Drive Queensway Wellingborough Northants NN8 3FR 01933 401613 01933 401615 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) Anchor Trust Mrs Elizabeth Jane Ross Care Home 48 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (48), of places Physical disability over 65 years of age (24) Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The total number of service users must not exceed 48 No service users with a physical disability over the age of 65 PD(E) may be admitted to the home when there are already 24 service users accommodated within the home 3. No service users with Dementia over the age of 65 (DE(E) may be admitted into the home where there are already 7 service users in the home 31 May 2005, an additional visit was carried out Date of last inspection on 26 July 2005 to check compliance with requirements. Brief Description of the Service: Bilton Court is a care home providing personal care and accommodation to forty eight older people twenty four who may have a physical disability and seven who may have a dementia related illness. Bilton Court is operated by Anchor Homes, which is part of Anchor Trust. Bilton Court is situated on a residential estate on the outskirts of Wellingborough with public transport to and from the town centre. The home has single bedroom accommodation with en-suite facilities for all service users on two floors. A passenge lift provides access to the first floor.There are four separate units within the home each unit having a communal lounge/dining room. There are pleasant grounds surrounding the home, which are accessible to all service users. Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over a period of approximately six hours from mid morning through to the afternoon of a weekday. Prior to the inspection the Inspector spent one and a half hours reading the report of the inspection carried out in May 2005 and the report of the additional visit in July 2005. This information was used to plan the key areas to be inspected. The inspection involved review of records relating to the assessment and planning of care needs and a review of the action taken to address previous requirements. Discussions took place with some residents, care staff, cleaning staff, activities organiser and the registered manager. Observations of the daily routines and interactions between staff and residents were made. There is a history of unmet requirements, which is of cause for concern to the Commission for Social Care inspection. Discussions have taken place with Anchor Homes about inspection findings and standards of care. The company have expressed their commitment to addressing the shortfalls and while there has been evidence of progress in some areas the continuing shortfalls create potential risks to Residents. As indicated in the report of May 2005 failure to comply with the statutory requirements will result in CSCI considering enforcement action, this remains under serious consideration and legal advice will be sought if the new timescales for compliance are not met. What the service does well: The premises are purpose built and with bedrooms and communal areas on each floor and a passenger lift they provide good access for wheelchair users to all parts of the home including the garden. The home was clean and comfortable providing a pleasant environment for Residents. Relationships between staff and residents were good and there was a comfortable and relaxed atmosphere in the home. A resident confirmed that they were receiving the care and support that they needed and that staff were helpful. Assessments of needs are carried out prior to residents being admitted to the home to ascertain if their needs can be met. Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 6 Complaints are responded to appropriately with remedial action taken where necessary and staff are aware of their responsibilities in relation to protection of vulnerable adults. A thorough recruitment process is in place, which includes carrying out relevant checks and seeking references prior to staff working in the home. What has improved since the last inspection? What they could do better: Requirements relating to the need for a nutritional plan of care and pressure area care plan for residents identified as being at risk have not been met. These plans are very important, as they are tools to guide staff in providing appropriate and consistent care. Information on care files relating to residents who manage their own medication needs to be accurate and there needs to be systems in place to assess, manage and monitor the risks to ensure that residents receive any necessary support to manage this safely. Previous requirements relating to this have not been met. The availability of soap dispensers needs to be checked to ensure that sufficient are available. Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 7 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. Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 8 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 Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, standard 6 is not applicable, as intermediate care is not provided. The assessment process provides assurances that the basic needs of people admitted to the home can be met. EVIDENCE: Records for a recently admitted Resident were sample checked which identified that an assessment had been carried out by the home prior to admission. A copy of the assessment of care needs carried out by the Local Authority and a copy of the care agreement with the funding body had also been obtained. A sample check of the assessments alongside the care plans confirmed that basic information had been transferred to the care plans to inform Staff as to the care needs to be met. As detailed in the following section more detailed information needs to be gathered and incorporated in the care plans regarding the level of assistance individuals need. Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 The continuing shortfalls in the planning of care and instruction to staff particularly in relation to pressure area care, dietary needs and risk assessment for self medication has the potential to put residents at risk. EVIDENCE: A sample check of residents care files identified that in spite of previous requirements relating to care plans they continue to contain minimal information regarding residents needs and are insufficient to guide staff in providing consistent and appropriate care. Previous requirements have been made relating to the need for assessments to be carried out to identify those residents at risk of pressure sores and those at risk of their nutritional needs not being met. An additional inspection visit to the home in July 2005 confirmed that the assessments were being carried out however requirements relating to the implementation of a care plan for those identified, as being at risk had not been met. Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 11 It is of concern that in spite of further requirements, review of a residents care file during this inspection identified that assessments were in place which confirmed a resident was at high risk nutritionally and at risk of pressure sores with no pressure area care plan in place, pressure relieving equipment or an adequate nutritional/dietary care plan. Staff are recording the residents food intake however this showed regular refusals of meals with no evidence of additional high calorie meals or snacks being offered. The registered manager has been asked to personally review this resident’s nutritional and pressure area care plans and submit copies of revised plans to The Commission for Social Care Inspection by Friday 21st October 2005. A sample check of resident’s files to check compliance with a requirement relating to the need to carry out risk assessments for residents who manage their own medication was carried out was found not to have been met. In addition a risk assessment was found on a relatively new residents file stating that he managed his own medication. The risk assessment was poorly completed and did not take proper account of the risks. Discussion with the registered manager identified that the resident no longer managed his own medication due to his inability to manage it safely. A resident confirmed that they were receiving the care and support that they needed and that staff were helpful. Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 The development of the activity programme and change of shift patterns has improved the daily lives of Residents. EVIDENCE: The appointment of a part time activities organiser and the provision of activities has made a big improvement to the life of residents. Records show that regular activities in the home include beetle drives, scrabble, bingo, coffee and quizzes. Outings have been organised such as a visit to a country park for a picnic and a theatre trip was being organised during the inspection. A resident told the inspector that she enjoyed the bingo sessions. The inspector observed two residents in the garden which has been tidied up and replanted and was informed that the two residents had done a lot of the planting and have spent a lot of time in the garden. This was particularly pleasing, as one of the residents had discussed on a previous visit the difficulty with having nothing to fill the long days. Where possible residents are encouraged to retain control over their lives in such areas as managing medication and their finances. There is a lockable facility in resident’s rooms, which provides secure storage. The way residents Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 13 care plans are written indicates that residents have been involved with them however discussion with a staff member highlighted a lack of clarity as to whether residents were allowed access to their files. Staff informed the inspector that changes to the shift patterns in the home has meant that residents are able to have the assistance they need at the time they need it in the mornings and do not have so long to wait for breakfast. Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Complaints are responded to appropriately with remedial action taken where necessary and staff are aware of their responsibilities in relation to protection of vulnerable adults. EVIDENCE: The Commission for Social Care Inspection (CSCI) has received no complaints since the last inspection. A log of complaints, concerns and compliments is kept in the home. A sample check of the complaints log indicated that relatives feel able to raise concerns and that all complaints and concerns are recorded regardless of the seriousness. Details of any actions taken to address the issues raised were recorded. Discussion with staff during the inspection confirmed that they are aware of their responsibilities in reporting any concerns regarding the treatment or care of residents. Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 The home was clean and comfortable providing a pleasant environment for Residents. EVIDENCE: The premises are purpose built and with bedrooms and communal areas on each floor and a passenger lift they provide good access for wheelchair users to all parts of the home including the garden. The home is divided into four separate units with two units on each floor. Each unit has a lounge, dining area and kitchen where drinks can be made. All bedrooms have en-suite facilities. Discussion with cleaning staff, a resident and a sample check of the premises confirmed that cleaning routines are in place and that the home is kept clean and tidy. Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 16 Staff confirmed that they have access to disposable gloves and aprons and have all been provided with alcohol gel as part of the infection control procedures. Paper towels are available in resident’s bathrooms however soap dispensers are only available in some of the bathrooms. Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29, 30 Arrangements for recruitment and induction of staff provide some safeguards for residents and relationships between staff and residents are good. EVIDENCE: The staff recruitment process was discussed with a member of staff who confirmed that following an interview references were taken up and she was not able to start work until these and a criminal record bureau clearance had been obtained. The induction process lasted two weeks however she confirmed that there was the option to extend this. There is a programme of staff training. The registered manager confirmed that currently ten staff are working towards National Vocational Qualifications and that weekly sessions have been arranged to provide staff with additional support. Discussion with staff during the inspection confirmed that staff morale has improved and that there is less reliance on agency staff since the last inspection. Residents spoken to confirmed that they are happy with the staff and relationships between staff and residents appeared to be good. Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 EVIDENCE: The Commission for Social Care Inspection has completed the registration process for the manager who was found to be sufficiently qualified and experienced to be registered as manager of Bilton Court. As part of this process the manager has agreed to undertake some additional dementia care training. Copies of reports of monthly visits conducted on behalf of the registered provider are being forwarded to The Commission for Social Care Inspection (CSCI). The purpose of these visits is to assess the care provided to Service Users and report back to the Registered Person in order that they are kept fully informed of the standards of care and are able to take any necessary action. Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 19 Following the inspections carried out in May 2005 and July 2005 CSCI have been informed about additional management support that has been provided to address the issues raised through inspection. Following this inspection and prior to the production of this report the inspector has been informed that additional support will be going into the home on Friday 21st October 2005 to ensure that requirements relating to nutritional needs and pressure area care are addressed. Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 20 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 1 8 1 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X 2 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X X Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 7, 8 Regulation 12 (1) (a & b) Requirement Timescale for action 16/11/05 2 7, 8 3 7, 8 Up to date care plans must be in place, which contain specific information regarding the individual needs including health care needs and be used to guide the actions of the carer. (Ongoing requirements have been made since at least since 27.12.04) 21/10/05 12(1a&b) Nutritional care plans must be 13 (4c) 17 implemented as determined by (1a) the assessment and take account schedule of individual needs and 3.3(m) preferences. Written confirmation of the action taken and a sample care plan as agreed must be submitted to The Commission for Social Care Inspection. (Previous requirements with timescales of 30.06.05 & 30.08.05 have not been met) 12(1) Pressure area care plans must be 21/10/05 (a&b) implemented as determined by 13(4c) the assessment and include 17(1a) instructions given by the District schedule Nurse. Written confirmation of 3.3 (n) the action taken must be submitted to The Commission for Social Care Inspection. (Previous DS0000012708.V250516.R01.S.doc Version 5.0 Bilton Court Page 22 4 9 12 (1) (a&b) 12 (2) 12 (3) 13 (2) 13 (4) (c ) requirements with timescales of 30.06.05 & 30.08.05 have not been met) Risk assessments for Residents who self medicate must take account of individual abilities, needs and wishes. Written confirmation of the action taken and a sample risk assessment must be submitted to The Commission for Social Care Inspection. (Previous requirements with timescales of 27.12.04, 11.02.05, 30.06.05 & 30.08.05 have not been met) 21/10/05 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 26 Good Practice Recommendations Availability of soap for hand washing should be reviewed to ensure that it is made available in all bathrooms. Bilton Court DS0000012708.V250516.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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