Inspection on 01/03/06 for Bilton House

This inspection was carried out on 1st March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 House 10/02/09

Bilton House 12/12/08

Bilton House 10/12/07

Bilton House 14/06/07

Bilton House 03/11/06

Bilton House 04/08/05

Bilton House 22/03/05

Bilton House 08/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Bilton House 5 Bawnmore Road Bilton Rugby Warwickshire CV22 7QH Lead Inspector Sandra Wade Unannounced Inspection 1st March 2006 09:30 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 House DS0000004210.V283441.R01.S.doc Version 5.1 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 House DS0000004210.V283441.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Bilton House Address 5 Bawnmore Road Bilton Rugby Warwickshire CV22 7QH 01788 813147 01788 811184 vmjakeman@yahoo.co.uk 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) Rugby Free Church Homes For the Aged Mrs Veronica Jakeman Care Home 33 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (16) of places Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th August 2005 Brief Description of the Service: Bilton House is a large building which has been extended over a number of years and has bedrooms on two floors which can be accessed by a lift. The property fronts directly onto Bawnmore Road and there is a large visitors car park at the rear of the home which can be accessed via a side entrance. The home is registered to accept 33 older people 17 of which are for people with a diagnosis of dementia. There is level access to the home for wheelchair users to the front and back of the home. The Clarence Cooper Unit accommodates 8 residents with a diagnosis of dementia, this is referred to as the specialist dementia care unit and the main building accommodates the additional 9 people with a diagnosis of dementia. Most of these residents occupy bedrooms on the ground floor. Both the frail elderly category residents and those with a dementia diagnosis freely intermingle with one another within the home. The Clarence Cooper Unit has its own secure gardens but there is also a large well maintained garden with a footpath which residents can utilise from the main building. All rooms in the main building have ensuite showers and toilets. The rooms in the Clarence Cooper unit have ensuite toilets. There are 32 rooms in all but the home have used one of the larger bedrooms as a double hence the registration for 33. There are 5 communal lounges plus large corridor areas which have seating and two dining areas one of which is in Clarence Cooper. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second inspection to Bilton House for this inspection year and took place between 9am and 6pm. This inspection focused on progress made in regards to the requirements made at the last inspection as well as the review of standards not assessed at the last inspection. On arrival to the home some residents were having breakfast but others were seating in the lounge reading or talking amongst themselves. A long period of time was spent in the Clarence Cooper Dementia Care Unit to observe and speak with residents and staff as well as review the care records for the residents in this area. Discussions were also held with residents and staff in the main house and a brief tour of the building was undertaken to confirm actions taken from the last inspection. Records relating to the policies and procedures of the home were reviewed. What the service does well: What has improved since the last inspection? Since the last inspection three of the bedrooms have been redecorated to improve the environment for the residents and the home have had some new beds. A new carpet and blinds have been fitted into the small lounge. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 6 A new washing machine has been purchased with a sluice facility so that heavily soiled and infected linen can be washed more effectively. Plans are underway to fit new carpets, provide a new kitchen, a new sluice room and complete more decorating within the home. 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. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 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 Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Information provided to prospective residents is not sufficiently detailed to enable residents to make well informed choices about whether to accept a placement within the home. All residents are assessed prior to moving into the home but not all records are available to confirm this. EVIDENCE: Bilton House is a residential home with a Christian ethos and is governed by a Board of Trustees from the Free Churches (referred to as the Committee in this report) which help to support the home in making decisions on how it is managed. This includes support in devising the Statement of Purpose document for the home which gives information about the care and services provided. The manager reported that the Statement of Purpose was referred to the Committee for updating following the last inspection and this is still in the process of being completed. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 9 All residents who are admitted to the home are assessed by the manager prior to admission. The admission process requires prospective residents to complete an application form and once this has been received by the manager a visit is made to see the resident to formally assess their needs. Once this information has been obtained this is presented to the Selection Committee for the home. Residents are selected in order of greatest need and those who are part of the Free Church are given priority. The assessment records for two residents were requested but records for one of these could not be located. The records viewed contained most of the information to confirm their needs but it was noted that the form does not ask for information on continence, personal care or personal safety and risk as specified in the standard. The assessment form does ask for church affiliation and the manager asks families to complete a “getting to know you” form so that as much information on the persons background, daily routines and social history can be considered when devising their care plan. Once a resident has been assessed and their placement has been agreed by the Selection Committee residents receive a letter to confirm their placement. Copies of these letters are available in the home. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 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): 7,8,9,10 Structured care plans are in place but some of the care needs are not always reflected in care plans so it is clear what staff actions are required to address them. A review of the homes policies and procedures for managing medications is required to ensure these are being managed safely. Residents were observed to be treated with respect and privacy is being maintained as appropriate. EVIDENCE: During the inspection a period of time was spent in the Clarence Cooper dining area where all of the residents in this unit have a diagnosis of dementia. It was observed that there are periods of activity and periods of calm depending on the residents behaviour. Staff were observed to be very patient and calming and in particular to one resident who constantly demanded their attention. At one point this resident became agitated which could have been linked to tiredness from wandering and they were encouraged to sit next to a member of staff who talked calmly to them and held their hand and eventually the resident fell asleep. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 11 The staff working on this unit were observed to be caring and supportive to the residents and showed an understanding of how to manage the complex needs of these residents. Despite some of the demanding behaviours, staff were careful to maintain the dignity of residents and were observed to treat the residents with respect. Any medical treatments or appointments are arranged so that residents can be seen either in their own rooms or the treatment room. The manager said that occasionally the offices are used depending on the treatment involved. Care plans were selected for review for the residents in the Clarence Cooper Unit. Care plans were noted to be detailed and set out daily routines for the residents. It was evident from talking with staff that one of the residents had a hernia. On viewing the care plan records for this resident it was clear that there was no specific care prescribed to address this. Care staff advised their was a care regime in place each day to manage this aspect of the residents care. It was not evident that the hernia had been followed up with the medical profession. During conversations with this resident it was evident that there were some communication difficulties. These were confirmed in a care plan so staff would know how to communicate effectively. Risk Assessments had been completed although these were not all dated making it difficult to establish the residents current needs. Care plans were mostly dated March 2005 so it was not clear these had been regularly evaluated to ensure any changes in their care needs had been identified and addressed. The daily routine sheet was also not dated to show this was reflected current routines. Social needs and participation in religious service had been documented including details of support provided by the Church Fellowship. This resident stated that they liked sitting in their room and said that they did not like it when one resident in particular came into their room uninvited. This resident was watching the television and had family photos in their view which they discussed and which were clearly important to them. This resident seemed content in the home and it was observed that staff were supportive and encouraging when the resident mobilised from their room to the dining area. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 12 A discussion took place with a member of staff regarding another of the residents. The member of staff stated that the resident had Parkinsons as well as a diagnosis of dementia and suffered from poor nutritional intake. It was also established that this resident had a sore on their toe. The care plans for this resident confirmed that the district nurses were visiting to dress the toe but there was no specific care plan in place in regard to the management of this wound in between district nurse visits. No body charts had been completed showing wounds. There was also no care plan in place in regard to the Parkinson to describe how this presented itself and what medical interventions had taken place. It was however established that there had been no formal diagnosis of this although it was clear the residents joints had become very stiff over recent months and this had affected their posture. The care plan in place for eating and drinking had last been evaluated in December 2005. This confirmed a small appetite and stated the resident had been “eating better lately”. This care plan did not indicate that food intake charts were to be completed but the care plan on Health Promotion did. Food intake charts viewed had not been completed consistently and on one day records showed that the resident had eaten a bowl of porridge and 2 artic rolls, 2 cups of tea and one cup of coffee. There were no indications that the resident had been encouraged or offered any additional snacks, drinks or meals. Sometimes records had not been completed with sufficient detail to get a full picture of the amount of food taken eg ate “all her dinner” ate “one sandwich” – it is not clear if this was a full 2 slices of bread sandwich or a quarter of a sandwich. This resident was noted to be of a low weight. The weight of this resident had not been checked and recorded consistently to show that staff were monitoring this resident for any weight loss which could result in ill health. The resident was noted to lose 8lb when weighed in May but this was not checked again until September when the resident had gained 3lb. Records showed that the last time this resident had been weighed was in November 2005. The manager confirmed that she had pursued the matter of poor nutrition of residents with the dietician and as a result would be implementing new risk assessments and procedures for staff to manage this effectively. An issue raised at the last inspection in regard to the management of hearing aids was reviewed. It was noted that a resident who wears a hearing aid did not have a care plan in place to confirm how this was being maintained to ensure the hearing of the resident could remain effective. The manager confirmed that none of the residents had pressure areas/sores. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 13 Daily records are being completed for each resident to confirm care needs are being met such as personal care, psychological care and whether they have eaten well. Due to some records being less detailed than others it was not always clear that all aspects of a residents care were being met. Residents in the home looked well cared for and content. One resident said that they liked it in the home “if they got their own way”. Another resident said that they had chosen to come to Bilton House and they enjoyed the company of the other residents. A review of medications was undertaken. Medications are kept in a dedicated room and medication trolleys plus a medication fridge are in use so that medications can be stored and administered safely. Some of the residents are taking their own medications but it was noted that there is no specific policy and procedure in place to ensure this process can be managed safely. Advice was given in regard to this matter. Gaps were noted on the medication administration records (MARs) so it was not clear if some residents had/had not received their medication. One record showed that 14 tablets had been signed for as given but there were only 12 missing out of the packet. For one resident Omeprazole had been prescribed as “one to be given at night”, the medication record showed that it was actually being given at 7.30am. The manager said that the doctor had agreed to this change but records had not been changed to reflect this. It was noted that the MARs contained stickers which staff confirmed were supplied by the Pharmacist to stick onto each MAR sheet as appropriate. This practice is not in keeping with safe medication practices as errors could be made. Co-codamol were found in a residents room and staff had removed these and placed them in the medication trolley. It was advised that appropriate actions be taken to pursue a supply from the doctor if required. All medications in use within the home should be prescribed by a GP to ensure safe management unless they are used as a homely remedy in which case the home need to implement an appropriate procedure. A bottle of lactulose in the medication trolley was noted to be dated January 2005, although the expiry date was not until 2007, it appears that staff are not using medication in the correct rotation. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 14 Loose paracetamol were found in the trolley so it was not clear who they had been prescribed for. The trolley was noted to be dirty and in need of cleaning. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 15 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): 13, 15 Residents can maintain contact with family/friends and the local community including church representatives if they wish. Residents receive an appealing diet but choices offered are not consistently recorded to confirm a balanced, varied and wholesome diet is being provided. EVIDENCE: Many of the residents at Bilton House have their own telephones so that they can make contact with family and friends in addition to any visits they may receive. The home have an open visiting policy and some of the residents have their own door key so they can go out independently. A brochure giving information about the home is provided to prospective residents and their families. This includes information on the arrangements for care as well as the services provided. During the last inspection it was advised that menus are reviewed. It was noted that the meals are now more varied but menus do not show that choices are being offered in regard to the main meal consistently. Menus show that Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 16 supper consists of a milky drink and biscuits which is not considered to be a “snack meal” as stipulated in the care standards. Due to the vulnerability and dietary intake required to maintain sufficient nutrition for the older people client group, a snack meal should be offered in the evening so that there is a gap of no more than 12 hours before the next meal. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Details of how to complain are not sufficiently clear so residents and visitors know what process to follow. EVIDENCE: There is a complaints procedure available in the home but this has not been updated since the last inspection. The complaints procedure does not detail the name, telephone number and address of the manager and does not state that complainants can write to the Commission for Social Care Inspection. No complaints have been received by the home since the last inspection. A policy on the prevention and management of abuse as well as Whistleblowing is in place. The manager reported that she had undertaken training with the care staff in regard to this matter. Since the last inspection the manager had identified that money had gone missing from the home. Actions taken by the manager to address this matter were appropriate to ensure residents were safeguarded from this happening again by the persons involved. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 18 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): 21, 25, 26 There are sufficient numbers of toilets and washing facilities but some repairs are required to one bath to enable all bathrooms to be operational. Residents live in safe and comfortable surroundings. The home is being maintained in a clean condition and systems are in place to maintain hygiene effectively. EVIDENCE: Since the last inspection actions have been taken to remove residents personal toiletries and nail scissors from the bathrooms. Toilets and bathrooms viewed were found to be clean and have sufficient washing and drying facilities. It was noted that one of the baths had a note on it stating “do not use out of order” the manager confirmed that arrangements were in hand for this to be repaired. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 19 All radiators within this home have covers to ensure there are no burn risks to residents from the hot surface temperatures. Hot water temperatures are being maintained to safe levels with thermostatic mixing valves although on testing some of the hot water taps one was found to be less than 43°C and one was found to be hot to touch. It was established that not all hot water outlets are being tested monthly to ensure these are maintaining their safe levels. Since the last inspection action has been taken to change practices in how commode pots are cleaned and dried. The manager advised that the home are to have a new sluicing machine and are awaiting a delivery date. The home have 3 washing machines and since the last inspection a machine has been obtained with an appropriate sluice cycle so that any heavily soiled or infected items can be cleaned thoroughly. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 20 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): 27, 29 The allocation of staff on the duty rotas is not sufficiently clear to confirm there are adequate numbers of staff in all areas of the home at all times to meet the needs of the residents. The homes recruitment policies and procedures are appropriate to support and protect the residents from harm but these are not always being followed. EVIDENCE: In addition to the manager there are three assistant managers who form the management team for the home. They support a team of senior carers/carers in meeting the needs of the residents. In addition there are specific staff who are employed for cleaning and catering duties and there is an activity organiser who is employed for 5 days a week. At the time of inspection the home was full and the manager advised there was a long waiting list. The manager reported that since the last inspection there have been less agency staff used within the home. Duty rotas show that there are between four and five care staff on duty plus an Assistant Manager during the day and 3 night carers. The manager works in a supernumerary capacity and is available in addition to these staffing arrangements. These staffing numbers meet with the Department of Health minimum recommended guidelines. It was established however during the inspection that there are an increased number of residents developing dementia. The manager advised that staffing continues to be closely Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 21 monitored to ensure the needs of the residents can continue to be met effectively. Residents spoken to in the main house stated that the staffing was “good” and they were well looked after. Duty rotas continue to be unclear in specifying which staff are covering the Clarence Cooper area of the home. There is a clear heading on the rotas for ‘Main House’ listing staff working in this area but this is not the case for the Clarence Cooper Unit. On the day of inspection there were two care staff working on the Clarence Cooper Unit and one domestic demonstrating that this unit was sufficiently staffed on the day of inspection. The manager was covering the cooking duties in the main house kitchen due to a member of staff being ill. It is also not clear from duty rotas which staff are covering laundry duties. Any hours allocated to this service must be clearly indicated on the duty rotas so that hours provided can be deemed as sufficient. A review of two staff files selected at random was undertaken to confirm actions taken in regard to requirements made at the last inspection. Photo identification was available on both files and one file contained a full employment history. Both files did not contain two written references. The manager advised that she does keep interview notes but these had not yet been placed on the staff files. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 22 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): 33, 35, 38 The home is run in the best interests of the residents but no formal system for monitoring the ongoing quality of care and services was evidenced. Systems are in place for managing residents monies but some action is required in regard to the management of the ‘float’ to ensure residents financial interests are fully safeguarded. Further work is required in regard to health and safety matters to ensure residents are fully safeguarded. EVIDENCE: The inspection process confirmed that residents feel they receive a good quality of service and a good standard of care. Residents observed during the inspection looked contented and well presented and those residents spoken to were positive in their comments regarding the home. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 23 The residents receive extensive support from the Churches and Bilton Friends group which helps to enhance their quality of life in the home. One resident spoken to confirmed the support being provided by the church. The manager meets with the Committee once a month which enables her to discuss any matters relating to the home which require the support and help of the Committee to maintain good standards within the home. During discussions with residents, one said they were able go on outside visits independently when they wished as long as they informed the staff. This person said that it was their decision to come to Bilton House and they liked the home. Another resident said that they liked the home and had been at the home for a while. One of the newer residents said that they had now settled in and they were being well looked after. The manager advised that a resident satisfaction survey has been devised but this has not yet been sent out to the residents. Outcomes of quality monitoring completed last year were not available in the home to view. The manager advised that meetings are held with residents but the notes of the meeting were also not available in the home to confirm the attendance and discussions held. A review of residents monies was undertaken. It was confirmed that the home have a residents account at a bank and all monies received are paid into this account as appropriate. A computer system within the home details all monies received and paid out so that each resident knows how much money they have at any one time. Records viewed confirmed that monies received and monies spent are being recorded on the system and receipts are being maintained as appropriate. The inspector was advised that at any one time the home maintain a ‘float’ of money which is withdrawn from the residents fund, it is this money that is used to give to residents when they request money and the computer records are updated as appropriate. This aspect of the management of resident monies does not comply with the current Care Home Regulations as this money in effect belongs to all residents. It would be difficult to identify how the home would investigate discrepancies if the money did not balance and decide whose account would be “out of synchronisation”. The personalisation of money is as important as the management of individual accounts. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 24 Health and safety records were reviewed to confirm the home is safe for the residents. The following checks were noted:Landlords Gas Safety Certificate 25.1.06 Five Year Electrical Wiring Certificate 18.5.00 (now overdue) Electrical Portable Appliance Testing 18.2.05 Hoist Service May 2005 Bath Chair – due 28.2.06 Lift 23.12.05 – manager advised sensors need to be looked at to ensure doors do not close too early when residents are using this. Legionella Risk Assessment – February 2005 – (now due) Fire check – 10.10.05 Call bells 16.9.05 The manager advised that the fire alarms are checked weekly and the Fire Risk Assessment for the home is to be updated. Fire drills are held 2 – 3 monthly. The Employers Liability Certificate was noted to have expired on 28.2.2005 . A visit undertaken by the Environmental Health Officer identified no problems. It was noted during the inspection that a cleaning cupboard near to room 5, garden wing had been left unattended and open. This was noted to contain a range of chemicals which could be a health and safety risk to residents. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 X X 2 X X X 3 3 STAFFING Standard No Score 27 2 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 2 X 2 2 Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 26 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 OP1OP37 Regulation 5 4(1)(c) Sch 1 Requirement The Statement of Purpose must be reviewed in line with Schedule 1 of the Care Home Regulations to ensure this on its own contains all of the required information. This is to include: * The removal of the reference to the National Care Standard Commission on the first page. *Making it clear that the home has a split registration for two catergories of care and detailing the arrangements in place for meeting the needs of these two categories of residents. This is to include details of where these residents are accommodated in the home and how integration of the two catergories is managed. *The Service User Guide must be a summary document of the Statement of Purpose and be treated as a separate document. This must contain the summary inspection report and make it Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 27 Timescale for action 31/05/06 clear where the full copy can be read within the home (this should be on display). (Above outstanding from August 05 inspection) 2. OP3OP37 14 (1) Resident assessment records must be available on file consistently to demonstrate assessments carried out. (Issue outstanding from August 05 inspection). 3. OP7OP37 12(1)(a) 15(2)(b) A further review of care plans is required to demonstrate that:Care plans fully detail the needs of the resident. Care plans are being reviewed on at least a monthly basis so that care needs are up to date. Actions required by staff to meet care needs are fully detailed. Daily records consistently report staff actions taken to meet care needs as specified in care plans. (Above issues outstanding from August 05 inspection) Care plans and Risk Assessments must be dated consistently. 30/04/06 30/04/06 4. OP8OP37 12,13,17 Sch3 Care plans must state specific actions on how to address hearing impairments including how to manage hearing aids so that service users can have effective hearing . Details within care plans must be 30/04/06 Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 28 more specific in terms of actual food and fluid taken for those residents who require their nutrition to be monitored. The manager must ensure that records which demonstrate staff competency to administer insulin are available within the home. (Above outstanding from August 05 inspection) For those residents with wounds, care plans must be devised accordingly showing how these are being managed. The manager is to confirm a date for the implementation of the new nutritional assessment tool and monitoring records for those residents with poor nutrition. Records must demonstrate medical interventions sought as appropriate in regard to Medical health care needs identified. 5 OP9 13 17 30/04/06 A review of medications is to be undertaken to ensure compliance with the Royal Pharmaceutical Guidelines “The Administration and Control of Medicines in Care Homes” to ensure safe practices are carried out at all times. The manager must ensure that a suitable policy and procedure is implemented in regard those residents who are self medicating to ensure this can be managed safely. Gaps on the MARs need to be explored. Staff must sign to say whether they have given/not given a medication. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 29 Records must demonstrate GP consultation in regard to any changes to medication dosages or times. Any handwritten entries on the MARs relating to this matter must be signed and dated accordingly. Staff must ensure that they rotate medication so that it is used in order of receipt. Any homely remedies being used by residents must be supported by an appropriate homely remedies policy. Any loose medications in the trolley must be returned to the pharmacist as appropriate. The manager is to review the use of stickers on the MARs with the Pharmacist as this is not considered safe practice. 6 OP15 16 The registered person shall having regard to the size of the care home and the number and needs of service users provide suitable, wholesome and nutritious food which is varied and properly prepared and available at such time as may reasonably be required by service users. In this regulation “food” includes drink. To demonstrate the above, the manager must be able to show through records all meal and drink choices offered to residents. Details of supper (which should be a snack meal) and snacks provided also need to be demonstrated. The manager is to confirm a date Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 30 31/05/06 for the implementation of actions as advised by the dietician in regard to nutrition and menus. 7 OP16OP37 22 The Registered Person must ensure the complaints policy and procedure is reviewed in line with this regulation to include: Who service users/visitors should approach in the first instance to make a complaint. What will happen in terms of investigating the complaint. Names, contact numbers and addresses of anyone whom the complainant is referred to. Details that any complaints received by Bilton House will be addressed by the manager within 28 days or sooner as appropriate. Include full name, address and contact number of the CSCI is detailed on the complaints procedure should the complainant wish to refer their complaint on to the Commission. (Above issue outstanding from August 05 inspection) 8 9 OP21 OP27OP37 23 18 17 The manager is to confirm a date 30/04/06 for the bath to be repaired. The manager must be able to demonstrate that sufficient staff are on duty at all times. The following matters are to be addressed. A review of duty rotas to contain:Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 31 30/04/06 30/04/06 Shift patterns of night staff. Clear details of which staff are working on the Clarence Cooper Unit. Details of which staff are completing laundry duties so that these can be deemed as sufficient. (Above matters outstanding from August 05 inspection). 10 OP29OP37 19 Sch2 Staff files must contain all of the required recruitment information consistently. Records must be closely scruitised to ensure any discrepancies are identified and resolved as appropriate. This includes: Two written references (one from last employer). The manager must be able to demonstrate that equal opportunities is being practiced during recruitment of staff (it is advised that interview notes are kept). (Above outstanding from August 05 inspection) 11 OP33OP37 24 The registered person shall establish and maintain a system for reviewing at appropriate intervals, and improving, the quality of care provided at the care home. The registered person shall supply to the Commission a report in respect of any review conducted and make a copy of the report available to service users. DS0000004210.V283441.R01.S.doc 30/04/06 31/05/06 Bilton House Version 5.1 Page 32 The manager must ensure that any system implemented allows for consultation with service users and their representatives. The manager is to confirm a date for implementation of the anonymous quality questionnaires. 12 OP35 20 The registered person shall not pay money belonging to any service user into a bank account unless the account is in the name of the service user, or any of the service users, to which the money belongs; and (b) the account is not used by the registered person in connection with the carrying on or management of the care home. In regard to the above regulation the manager is to review current systems for managing residents monies in regard to the “float” to ensure this is not made up of money from residents accounts. 13 OP38 12 13 The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of the residents. The manager is to confirm dates for the following health and safety checks to be carried out:Five Year Electrical Wiring check Electrical Portable Appliances Bath Chair Legionella Risk Assessment The manager is also requested to forward a copy of the updated Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 33 30/04/06 30/04/06 Employers Liability Certificate. The manager is to confirm a date for the Fire Risk Assessment for the home to be updated. The cleaning cupboard containing chemicals near to the Clarence Cooper Unit must be kept locked at all times when not in use. 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 OP25 Good Practice Recommendations It is advised that the temperatures of all hot water outlets in resident areas are monitored on a monthly basis so that any failing Thermostatic Mixing Valves can be identified promptly and water temperatures maintained safely. Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 34 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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. Extracts may not be used or reproduced without the express permission of CSCI Bilton House DS0000004210.V283441.R01.S.doc Version 5.1 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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