Inspection on 10/12/07 for Bilton House

This inspection was carried out on 10th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bilton House 10/02/09

Bilton House 12/12/08

Bilton House 14/06/07

Bilton House 03/11/06

Bilton House 01/03/06

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 Martin Brown DRAFT: Key Unannounced Inspection 10th December 2007 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.V356167.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. Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bilton House Address 5 Bawnmore Road Bilton Rugby Warwickshire CV22 7QH 01788 813147 01788 811184 care.biltonhouse@btconnet.com 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.V356167.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th June 2007 Brief Description of the Service: Bilton House is a residential care home with a Christian ethos and is governed by the Trustees of Bilton House charity. The aim of the charity is to provide a home for the care of older people within the liberal Free Church traditions, and to enable each resident to continue living as independently as possible. The home was established as a residential home for older people in 1946. 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 Clarice Cooper wing accommodates eight residents with a diagnosis of dementia, this is referred to as the specialist dementia care wing and the main building accommodates the additional nine 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 Clarice Cooper wing has its own secure gardens and 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 Clarice Cooper wing 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 five communal lounges, large corridor areas, with seating, and two dining areas. At the time of the inspection visit the fees are based on dependency levels and are charged in the range £390.00 - £555.00 per week and payable in advance by either cheque or standing order. The fees do not include newspapers, toiletries or hairdressing. Payments for chiropody are subsidised by the charity and the cost to residents is usually in the region of £5.00. Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been made using evidence that has been accumulated by the Commission for Social Care Inspection. The inspection visit was unannounced and took place on 10th December 2007, between 9.30am and 5.30pm. During that time, many of the residents were spoken with. A number of residents have cognitive impairments and found it difficult to engage in conversation. Staff and management were spoken with, and interactions between staff and residents were observed. One relative was spoken to by telephone following the inspection. The Annual Quality Assurance Assessment, completed and returned by the manager earlier in the year, also informed the inspection. Policies and procedures and care records were examined, and four residents were ‘case tracked’, that is, their experience of the service provided by the home, was looked at in detail. Staff, management and residents, were welcoming and helpful throughout the inspection. What the service does well: The service provides a warm friendly atmosphere that meets a variety of needs and is very much appreciated by the residents. Typical comments were ‘marvellous’ ‘couldn’t be faulted’ and, from one person “I’ve been in expensive hotels that haven’t been as good.” Just as importantly, those who were not as able to clearly articulate their views showed by their general well-being actions, and words, that they were well-served by being at the home. One lady, who told me she had been here since she was seven years old, was nevertheless able to acknowledge that ‘everyone is very good here’, as was another long standing resident who told me she’d only just arrived, but thought it ‘all very nice.’ The staff are very attentive and knowledgeable concerning individual needs, with residents and relatives rating them as ‘fantastic’. The needs of dementia residents are catered for by attentive and understanding staff who were clear on individual needs and how to meet them. The environment is well-maintained and clean; again, this was noted and commented on favourably by residents. The garden is a much-appreciated Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 Page 6 asset, and the home has a variety of well–maintained communal areas, as well as attractive bedrooms. What has improved since the last inspection? 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. Bilton House DS0000004210.V356167.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 Bilton House DS0000004210.V356167.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that the home assesses their needs and only accepts them if it is confident it can meet those needs and that they will benefit from the service the home provides. EVIDENCE: A brochure (Service User Guide) with information about the home and the admission process is available to anyone who is considering moving into the home. The procedure for moving into the home includes a visit by the Manager to the prospective service user to carry out a preadmission assessment, so that the home can be sure the individuals’ needs can be met before any decision to move in to the home is made. This process had been confirmed by a resident at the previous inspection earlier in the year. Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 Page 9 The manager gave examples of potential residents not accepted by the home as they were unable, following assessments, to meet their needs. These had subsequently been assessed as needing nursing care. One recent admission had been in the home for almost three months, and was, the manager advised, now due for a three-month review. She had been on a ‘short stay’ visit previously, and had been on the waiting list. The manager further advised that residents were only accepted if they themselves showed a positive wish to move here, or, in the case of those whose dementia made such decision-making less straight forward, had a trial placement and showed themselves accepting of a permanent move to Bilton House. A resident was spoken with who was moving into the home, and was happy and at ease with this prospect, if a little unsure, because of memory loss, of the exact circumstances surrounding the move. The home does not provide intermediate care therefore standard six was not looked at. Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The otherwise very good care experienced by residents at the home is potentially compromised if management does not ensure that administration and recording of all medication is recorded and accounted for in a clear and accountable manner. The manager’s determination to act to ensure this should lead residents to be confident that any shortfalls in this respect will be promptly rectified. EVIDENCE: A sample of four care plans were looked at, with a concentration on care plans for people with dementia. These were seen to have relevant details of individual care needs, including life histories, ‘well being indicators’ and ‘stress and coping indicators’. Discussion with staff supporting these persons, and observation of interaction and support, showed care needs being met in ways indicated on care plans. Staff were seen to provide support in warm, reassuring and relevant ways, and in discussion were able to demonstrate their knowledge and awareness of how to manage and diffuse potentially challenging situations. Staff showed good awareness of supporting dementia residents with irregular sleep patterns and were supportive of matters and possessions deemed important by these residents, and showed a good Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 Page 11 understanding of how things of note in their lives, such as musical abilities and past work, might impact on their current actions, likes and dislikes. Care plans were updated regularly, and all those looked at had had a monthly review this month, except one, whose last review was in early November. The manager advised that the key worker for this person was absent, and agreed that in the case of a prolonged absence, there should be a mechanism to ensure reviews and other issues were picked up by another worker. This resident had, staff advised, started to go to sleep on the floor on occasions. This was a new development, which discussion evidenced was being responded to appropriately and consistently by staff, but there was no evidence of this being recorded as part of the person’s care plan yet. Residents were well presented for example clothes were clean and well cared for and fingernails were clean and trimmed. One relative spoke of the care and effort the home puts in to ensure that all residents are well-looked after and well-groomed, saying the care is ‘exceptional, and couldn’t be bettered’. This relative had particular praise for the thorough and sensitive nature of the dementia care. Care plans showed details of health contacts as required, with input and support from district nurses as necessary. Discussion with staff and management, and examination of records, showed a good awareness of skin frailties and pressure sore awareness, with those at particular risk from developing pressure sores being successfully managed at present by use of suitable equipment and regular attention, movement, observation and prompt action where necessary. One relative said that any bruises were always promptly noted and attended to. Two residents at present have bed rails. The documentation for one of these was examined and seen to be appropriately recorded and risk assessed. Staff were observed respecting residents’ dignity, always knocking on doors before entering, and throughout helping and responding to residents in a manner which enhanced, rather detracted from, their dignity. Residents spoken with in the ‘main’ part of the building were very complimentary about the home, saying that staff were always available if they wanted or needed help. The administration and recording of medication was examined. This had been rated as poor at the previous key inspection in June 2007, although a followup inspection by the pharmacy inspector noted a commendable improvement to an acceptable standard. On this occasion, anomalies were noted on three ‘blister’ packed medications. Two had medications from the very last day of pack removed, whilst one had a vitamin medication remaining for one day of a previous week in a pack. Medication Administration Record Sheets showed all Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 Page 12 medications being given correctly. Staff spoken with all said that the missing medication was likely to have been because of a shortfall carried over from a previous month that had not been corrected with the pharmacist, and that the vitamin pill was likely to have been an excess from a previous month. There was no record to indicate that this was the case, and the person responsible for re-ordering medications had no record of this. From discussion with staff and management, it was deemed likely that that there had been no incorrect administration of medication, but the lack of clear recording to account for two medications being used out of sequence could not rule that out. Following the discovery of this shortfall, the manager advised that she would take direct responsibility for the medication to ensure that any anomalies were clearly recorded and corrected. She discussed consultation with, and a possible change in, the pharmacy, and additional training for staff, and clear instructions regarding clearly recording and promptly rectifying any dispensing from ‘blister packs’ out of sequence. Confirmation in writing was received from the manager the following day in respect of all these actions, as follows: “I have visited our pharmacy and spoken about having all medication blister packed, including all short stay residents medication. I have also requested a visit from the area pharmacist so that my team can be reeducated in all aspects of administration and stock control. I have implemented a new policy regarding storage and monthly ordering of medication and I will be overseeing and supervising all procedures undertaken by all trained staff.” Some medications were not ‘blistered packed’ either because they were unsuitable for this, or, in one instance, because the person concerned was a new arrival. The amounts remaining of a sample of these medications were checked against the amount detailed as having being brought in, minus the amount recorded as having been dispensed, and found to be accurate. However, the lack of daily ‘counting down’ of medication as part of stock control meant that any discrepancy would not be picked up until either a spot check of medication was done, or until the end of the four weekly cycle of medication being dispensed. Medication Administration Record Sheets had details of the resident concerned and detailed allergies. Individual records were not preceded by a photograph of the resident concerned. This was recommended to the manager as a way of helping to avoid any mistakes. One morning medication in a blister pack was required to be given earlier than others. This was therefore on the top of the pack. It did not have a name card preceding it, as all other medications did, leading to potential misunderstanding. The staff spoken with agreed to rectify this. Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 Page 13 A staff member was observed dispensing medication at mealtime in a safe, calm, and discrete manner. This was their sole task whilst others were managing all other aspects of residents’ needs. Staff when asked, were clear on the purpose of some, but not all, medications. One medication had been stopped after consultation with the hospital and recorded agreement from the doctor when it was apparent to staff that the ailment it was being taken for was no longer suffered. Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy a variety of activities in accordance with their needs and wishes, are supported in the maintaining of contacts with friends and relatives, and enjoy a balanced diet in pleasant surroundings. They are supported in exercising choice and control in their daily lives. EVIDENCE: Residents were seen to be enjoying a variety of activities throughout the day. In the morning, many residents were enjoying a regular aerobics session. One resident commented positively that ‘there is a different activity every day’. Records showed that such activities took place regularly. Staff pointed out one resident who was now joining in and benefiting from the exercise and socialisation after initial reluctance. Later in the day, people in the lounge were seen enjoying reading, various puzzles, or conversation. Televisions were in communal areas, but were only seen on in individual rooms. On Clarice Cooper wing, a radio, rather than a television, was on, thus providing background music, without potentially distracting or confusing images. Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 Page 15 Several residents were enjoying doing crosswords from the morning papers, and several residents were enjoying a game of scrabble later in the afternoon. There were lots of jigsaw puzzles available. Residents spoken with confirmed comments from management and staff that there were various opportunities for religious observance. All residents spoken with said they were content with the level of activities available at the home. Friends and relatives are welcome, and are able to support individuals in activities, particularly involving going out anywhere. Visitors dropping in throughout the day were evident. One relative spoken with said she often ‘popped in’ and was always welcome, and always witnessed the same high standards. Residents were seen to do as they wished, either joining in activities, or spending time in their rooms. One resident with irregular sleep patterns is supported in this, with appropriate medical support. Residents were seen throughout the day being offered choices and supported in decisions. One staff spoken with was clear, in respect of someone with a severe degree of dementia, that they were still able to make definite decisions in particular areas. Residents on the Clarice Cooper Wing were seen to have staff attention in accordance with their wishes and needs, with those asleep given regular checks and moves in accordance with care plans. One relative praised the care given in the home very highly, and this was observed, with staff ensuring the person was supported and occupied and stimulated in a positive way by frequent staff contact and reassurance. A meal was taken with residents. This was tasty and well-presented, and everyone was presented with a choice. Comments included ‘the meat is tender’ and the pudding is ‘full of fruit’. Mealtime was a quiet relaxed affair, with residents being attended by staff and supported where needed. Special dietary needs, notably diet-controlled diabetes, are catered for. Cranberry juice was offered to residents as an addition/alternative to water. All residents spoken with said the food was always good, and that they were offered plenty of drinks and snacks throughout the day. Fruit and snacks were in evidence in communal areas. Staff on the Clarice Cooper wing were observed to regularly encourage drinks and small snacks where necessary. One resident managed to recall a meal that she hadn’t particularly enjoyed, but said that this had been a long time ago. Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 Page 16 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, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected from abuse by the procedures and practices of the home, and can be confident that concerns raised will be listened to. This would be further enhanced if clear records were kept of responses to issues raised at residents’ meetings. EVIDENCE: The complaints log was seen, and detailed one complaint from the past year. This involved a resident of the home being in the street inappropriately dressed. The manager was able to explain the circumstances around this complaint and how it had been responded to, and steps taken to minimise a reoccurrence of the situation. All residents spoken with were very complimentary about the home, saying that the staff were ‘fantastic’ and ‘marvellous’. One resident commented that she had tried hard to think of something to complain about, but couldn’t think of anything. Another said that she had nothing to complain about, but if she had she would ensure that she was heard. Relatives spoken to had only praise for the service. Minutes of residents’ meetings showed issues of concern being raised, although from the records it was not always clear how they had been responded to. The manager was able to satisfactorily clarify individual issues. Staff spoken with showed a good awareness of abuse issues, and of what to do if abuse of any sort was suspected or reported. The manager showed a good Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 Page 17 awareness of local arrangements for reporting abuse issues, and of the need for full Social service involvement. Staff have had abuse training, and further ‘refresher’ training is planned. Staff spoken with showed a good awareness of residents’ rights in respect of decision-making, reflecting awareness of the Mental Capacity Act. Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a homely, clean and well-maintained environment, which they value. Further development and refurbishment to the home should further enhance the environment. More ‘user friendly’ signs notices in relevant areas of the home may help orientate confused residents. EVIDENCE: The home was seen to be clean and well-maintained during this unannounced inspection. There was a faint odour in some areas where incontinence was a particularly acute issue. Cleaning was taking place in selected areas in a very thorough manner in the morning. Several residents’ bedrooms were seen. All were pleasant, well-furnished and personalised. All residents spoken with said they were pleased with their rooms. Two residents both claimed their rooms had ‘the best view in the home’. Many of the rooms look directly out of the very attractive and wellmaintained gardens. The main building is very ‘grand’ with high ceilings and Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 Page 19 much wood panelling, but it also had a ‘homely’ feel, and residents obviously felt quite at home. The Clarice Cooper wing is a newer extension to meet the needs of those with advanced dementia, and provides a smaller, more intimate area where a smaller group of people were supported in comfortable surroundings. Equipment and aids were in evidence to support residents. Items such as wheel chairs were stored appropriately in designated areas. There are two lifts for the use of residents on the first floor. This floor, like the rest of the home, was well-maintained and clean. Christmas decorations were in the process of being put up. Refurbishment is planned for particular areas, with redevelopment of the kitchen and changes to lounges being planned. The cook was keenly awaiting a refurbished kitchen. Bathrooms and toilets were suitable for their intended users, although one downstairs bathroom, with floral wallpaper and some paper peeling from one wall, is in need of renovation. This bathroom also had a mirror and two pictures loosely hung on the wall, presenting a potential hazard, particularly to someone with dementia and/or unpredictable behaviour. All residents’ doors had small hand-written name plates on. Some residents’ doors had larger notices on where this was judged to be beneficial. There were few such notices in Clarice Cooper wing. The manager advised that these had been pulled down by a resident. A discussion was had about using more permanent signs where necessary, to help orientation. The laundry was seen to be operating effectively and in a clean, hygienic and ordered manner. The system for managing soiled laundry was satisfactorily explained. The issue of missing laundry had been raised at a residents’ meeting, but this was not seen as a problem by any residents spoken with. Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from the attentions of sufficient numbers of suitably recruited and trained staff, who support and maintain their dignity and well-being. More training for those with responsibility for administering and recording medication may further ensure residents’ well-being. EVIDENCE: There were sufficient staff on duty to meet the needs of the residents, with several residents spoken with commenting that staff are always available to help if needed. There are call bells for use, but these were heard very infrequently during the inspection. One resident I spoke with dropped her pen. I picked it up for her at her request and asked what she would have done if I had not been there. She responded that a member of staff would have soon come by and she would have got her attention. Staff were seen to be attentive of residents needs throughout the inspection and particularly where residents have dementia, were seen to re-assure and check their well-being. Comments from residents were universal in their praise of staff, with ‘marvellous’ and ‘fantastic’ being typical. One relative spoken with at length praised the staff, saying that they are ‘so kind, and attentive’. I was advised that no agency staff were used, with additional cover being provided by ‘bank’ staff who were all familiar with residents. Staff spoken with all showed familiarity with and a good knowledge of individual residents’ Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 Page 21 needs, with staff spoken with all having worked at the home for a number of years. Recruitment files were looked at. The manager advised that there had been only one new staff recruited since the last inspection. The files for this person showed satisfactory recruitment processes, with references, Criminal Records Bureau checks and application forms all in evidence. The staffing matrix, and discussion with individual staff, showed ongoing training taking place, with over half the staff team either having National Vocational Qualification level two or currently undertaking it, with other staff taking level three. The manager advised that all care staff have undertaken dementia care and all staff spoken with concerning dementia were aware and knowledgeable on the needs associated with this condition. This knowledge and awareness was reflected in observed practice, and in favourable comments from relatives and residents themselves, and in the well-being observed amongst residents. Those administering medication have received training in this area, but shortcomings have been noted in medication recording elsewhere in this report. Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a home that is well-run in their best interests. the health, safety and wellbeing of residents is potentially compromised if hot water outlets cannot be demonstrated to be only operating at safe temperatures. EVIDENCE: The Manager is experienced and has been at the home since September 2000. She holds a Higher National Diploma in Gerontology and a City and Guilds Advance Management in Care. She has completed the certificate in dementia care, showed a thorough awareness of all issues surrounding dementia care and has now commenced the Registered Manager’s Award. Residents, relatives, and staff spoke of the approachability of the manager. The manager demonstrated an open-minded and receptive approach, and a determination to put right identified shortfalls. Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 Page 23 Comments from residents and relatives showed that they felt the home was being run with the best interests of the residents at heart. ‘Exceptional… couldn’t be bettered’ was a comment from a relative. Questionnaires issued by the home and returned from health professionals were all very positive. Surveys sent out by the home to residents and relatives were generally very positive. Where there were concerns expressed, such as one person writing that tea was ‘rushed’, the manager had spoken to the team to ensure this perception did not persist. The treasurer for the home advised that the home does not keep any cash on behalf of residents as there had been concern over keeping large amounts of cash and/or having bank accounts for residents. Instead, expenditure of residents is paid by the home and a log kept, with receipts wherever possible, and an accumulated bill sent to whoever is responsible for each resident’s finances on a monthly basis. The treasurer advised that this system has just been implemented, and the service hopes for a favourable response from relatives and residents. Records showed regular safety checks for gas, electricity, and legionella. Following a requirement in the previous inspection regarding hot water temperatures, the home has employed outside contractors to check temperatures of all hot water outlets. Records showed that temperatures in some outlets had exceeded 43c. and the home could not demonstrate that, in all cases, this had been acted upon. The person responsible for maintenance of safe hot water temperatures advised that baths had never been fitted with mixer valves as they had manual ones reliant on staff to mix to safe temperatures. He was informed that this was unacceptable and that baths, like all other water outlets, must only dispense hot water at safe temperatures. The manager advised that this would be implemented and responded in writing the following day with outlining plans to bring in an outside contractor to rectify any shortcomings. Staff spoken with all demonstrated a good awareness of the importance of safe water temperatures, but the manager readily accepted that this alone could not be perpetuated as a sufficient safeguard. Fire records showed that equipment and alarm checks were regular. Staff showed a good awareness of procedures in the event of alarms sounding, and of the needs of residents in such circumstances. Fire doors are in place as required, allowing residents’ bedroom doors to remain open safely where they wish them to be. Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 Page 24 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 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 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 3 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 Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 Page 25 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 OP9 Regulation 13(2) Requirement Medication from ‘blister packs’ must be dispensed in strict date order. Any use of medication in blister packs from other than the designated date must be clearly documented, and rectified as soon as possible, so that residents can be confident that all medication is being administered appropriately. Stock control of all ‘non blistered’ medication must be more thorough, so that any mistake in administering medication can be immediately identified and rectified, so that residents can be confident that medication is being administered appropriately. The service must be able to demonstrate that residents are fully protected from the risk of scalding from hot water outlets. Timescale for action 15/01/08 2. OP9 13(2) 15/01/08 3. OP38 13(4)(a) 15/01/08 Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP7 Good Practice Recommendations To ensure residents benefit from regularly updated care plans, any prolonged absence by a key worker should be covered by another worker or manager. Staff should have an awareness of the nature of all medications dispensed, to enhance their understanding of individual resident’s needs and well-being. Photographs of individual residents preceding medication sheets would help ensure accuracy in dispensing. It is advised that the manager regularly assesses staff competence in medicine management in line with their regular supervision to ensure that staff continue to safely administer medicines. The use of ‘user friendly’ signs in relevant parts of the home may help those who have difficulty orientating themselves. It is recommended that the downstairs bathroom with patterned wallpaper is a priority in any refurbishment plans to enhance the well-being of residents. Any mirrors and pictures on walls in communal areas accessible by residents with dementia and/or potentially challenging behaviour should be securely attached to the wall, unless a risk assessment indicates this is not necessary, so that residents are protected from unnecessary hazards. OP9 OP9 OP9 5 6 7 OP19 OP19 OP19 Bilton House DS0000004210.V356167.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Birmingham Local Office 1st Floor Ladywood House 45-56 Stephenson Street BIRMINGHAM B2 4UZ 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 © 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.V356167.R01.S.doc Version 5.2 Page 28 - 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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