Inspection on 14/06/07 for Bilton House

This inspection was carried out on 14th June 2007.

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 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 Jean Thomas Key Unannounced Inspection 14th June 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.V338324.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.V338324.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 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.V338324.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd November 2006 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.V338324.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This was a key unannounced inspection visit, which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for the people living at the care home. The visit to the service took place on Thursday 14th June 2007, commencing at 09:30am and concluded at 6pm. The Manager was present during the inspection. Documentation maintained in the home was examined including a number of staff files and training records, policies and procedures and records maintaining safe working practices. Three people living at the home were identified for close examination by reading their, care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ and where evidence of the care provided is matched to outcomes for residents. A tour of the building and several bedrooms was made and general observations of working practices (including a meal time) and staff interaction with residents were included in the inspection process. The Inspector had the opportunity to meet most of the residents by spending time in the communal lounges and talked to several of them about their experience of the home. A number of residents have cognitive impairments and found it difficult to engage in conversation. The Inspector talked to the Manager and a number of staff members, and at the end of the inspection, feedback was given to the Manager and to the Chairman and Treasurer who are the Trustees of the Bilton House charity. The report uses information and evidence gathered during the key inspection process, which involved a visit to the home and looking at a range of other information. This includes the home’s service history and inspection activity; notifications made by the home, information shared from other agencies and the general public. Since November 3rd 2006 when the last key inspection of the service took place there have been no complaints made to the home and none to the commission. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 6 The inspection found that the home is well resourced and residents who were able to express their views and opinions said they were satisfied with the service provided. Comments noted include: Im extremely comfortable here and the staff are very obliging I like spending time in my room and if I need help with anything the staff are always on hand I like the food The home operates a key working system and residents were aware of who their key carer was. Residents spoken said they had good relationships with their ‘key carer’ who was available and provided the support they needed. What the service does well: Bilton House is a home with a Christian ethos and services of worship are held twice a week. The home is governed by the Trustees of Bilton House charity who are closely involved in the management of the home as well as fundraising to pay for outings and entertainments that enrich the lives of residents. A range of specialist equipment is available and used for the benefit of residents who also have access to community health care services and treatments as they would if living in their own home in the community. Staff attend a range of training and development courses to make sure they understand and promote safe working practices and meet the needs of residents. The home is clean and well maintained. There are five lounges plus additional seating areas and residents are free to utilise all areas of the home. Residents are encouraged to personalise their rooms and can choose their own carpets, which are purchased by the home. The home has a programme of ongoing maintenance and refurbishment. Residents’ have access to spacious and beautifully maintained gardens. There is a level path around the garden and suitable seating for a number of residents who like to spend time outside. Staff present as being supportive of residents and friendly interaction takes place between residents and staff. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Make sure that rigorous staff recruitment procedures are used when appointing new staff so that residents are safeguarded. The home needs to continue to develop care plans so that the information more accurately reflects the individual needs of residents and so that staff have access to the information they need to meet residents’ needs. In order to promote and maintain safe working practices and to make sure residents’ have their health care needs met improvements are needed in the way medicines are managed. Detailed risk assessments must be carried out for any activity that may pose a risk to residents. For example, the use of bed rails and self-administration of medication so that the home can be sure residents’ health and safety is promoted and maintained. The outcome of any risk assessment must be used to inform care planning so that practices are safe and residents have confidence in the environment. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 8 A programme of therapeutic and meaningful activities suited to the needs of residents requiring specialist dementia care should be provided so that people with specialist care needs can be confident their needs will be met. A system is in place for reviewing the quality of care provided at the home. Questionnaires are used to seek the views and opinions of residents and their relatives or representatives. The quality review process should be further developed to include other stakeholders such as, Community Nurses, GPs and other Health and Social Care Professionals. The outcome of any quality review should be used to further improve services. 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.V338324.R01.S.doc Version 5.2 Page 9 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.V338324.R01.S.doc Version 5.2 Page 10 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): 1 and 3 Quality in this outcome area is good. People considering moving into the home are supplied with the information they need to decide whether the home can accommodate their needs. Pre admission assessments carried out by the home ensure individual needs can be met. This judgement has been made using available evidence including a visit to this service. Standard six is not included in this judgement, as the home does not provide intermediate care. 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. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 11 One of the residents spoken to had recently moved into the home and confirmed the Manager visited them before they moved in and had talked about their needs. Information about services available at the home was supplied and the resident felt fully informed. The resident’s care file was read and confirmed the Manager visited and carried out a care needs assessment. The information held was deemed sufficient to know whether the care home could meet the individuals needs. The information gathered during the home visit and other information obtained after the resident moved in was used to formulate a plan of care. The resident was aware of the information held on the care plan and said they had been consulted about the content. The home operates a key working system, which means each resident has a named carer responsible for making sure his or her needs are met. The inspection concluded that shortfalls in the preadmission assessment process identified during the last key inspection visit had been addressed. The home does not provide intermediate care therefore standard six was not looked at. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor. Each resident has a plan of care and access to range of health care services. Residents are treated with respect. The absence of risk assessments is unsafe and place residents’ health and safety at risk. The management of medicine is unsafe and place residents at risk of not having their health care needs met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of three care profiles showed residents have a care plan and a personal profile that includes some life history, previous medical history and details of any current health care needs. Some of the information held was detailed and informative. For example, the resident was assessed as having ‘frail skin’ and at risk of sustaining tissue damage. To minimise the risk of skin damage to their legs an assessment identified the need for a support dressing (tubigrip) to be worn. Observations of the resident during the visit confirmed this occurred. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 13 Records showed that a resident was having difficulty mobilising and in response, the home made a request to the General Practitioner (GP) for a wheelchair to be supplied. A further care plan showed that although the assessment identified the need to wear spectacles the resident had chosen not to do so. Observations showed the resident did not wear their spectacles and therefore their right to make decisions was respected. A number of gaps in care planning and risk assessing were identified. For example, the care plan identified the need for two carers to provide support with mobility when the resident was walking ‘long distances.’ The information failed to identify what support was required or what was considered ‘long distances.’ The care plan showed the resident required assistance with all personal care but did not identify what was required. A detailed risk assessment had not been carried out for a resident who had bed rails fitted. Information recorded on the care plans of residents requiring specialist dementia care and who could not make informed choices did not include daily routines which are necessary for making sure residents have structure and continuity in their daily lives. Examination of a care profile belonging to a resident identified as having ‘severe dementia’ and observations during the inspection visit showed gaps in care provision. For example, the care plan showed that depending when family members visited then 7pm to 8pm was the preferred time for the resident to retire. The care plan did not identify the preferred time for getting up in the morning. Daily monitoring records did not include time the resident retired therefore staff coming on duty the following day may not be aware of how much time the resident had spent in bed. On the day of the inspection visit information supplied by staff members showed they supported the resident to up at 10:45am and if the resident had gone to bed within the timescale identified on the care plan then the time spent in bed would have been at least 14-16 hours and may result in needs not being met. When asked about the resident’s sleep pattern and how this was managed a staff member said the resident ‘goes to bed when she is ready’ and when asked how the staff knew when the resident was ready the worker said, she usually falls asleep in her chair.” Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 14 Information about the resident’s nutritional needs is referred to in the Daily life and Social Activities outcome group of the report. Records showed that although regular care plan reviews are carried out but care plans are not always updated to reflect any change in needs or circumstances. For example, the need for bed rails had not been identified during the care plan review or included in the care plan. Regular weight checks are carried out and the outcome recorded but in some instances, staff used both metric and imperial weights, which make it difficult to identify any weight gain or loss. The content and quality of daily monitoring records varied and was found to be somewhat repetitive and did not always show how or whether individual needs were being met. The dates entries were made were recorded but the time was not and staff coming on duty may not be informed of when events occurred. Documentation held on each care file showed that residents have regular access to GPs, opticians, chiropodist and other community health care services such as the community nurse. The Manager talked about the arrangements for managing continence and said any advice needed was sought from the continence advisor based at the Orchard centre or the Community Nurse who also supplies continence aids as necessary. One resident spoken to said she had incontinence pads supplied by the home. Residents spoken to said the staff provided support with personal hygiene and they usually have a bath at least once a week. A number of concerns about the management of medication were identified. For example, a visit to the room of one of the resident’s case tracked showed three Sinemet tablets had been left on top of a chest of drawers and other medication in the room was not stored safely or securely. The resident had chosen not to have a key to their room therefore other people in the home could enter the room and have easy access the medicines. A consent form signed by the resident was read but a risk assessment necessary to determine whether the resident was able to manage their own medication safely including the arrangements for ordering prescribed medicines and safe storage was not included. Medication held by the home and administered to residents by staff was stored in a secure medicine trolley but eye drops and ointments requiring cold storage were held in an unsecured food fridge in the kitchenette on the Clarice Cooper wing and where the majority of residents requiring specialist dementia care are accommodated. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 15 Fucithalmic eye ointment prescribed one drop in the left eye twice a day and dated 08/05/07 had not been opened. Levobunolol 0.5 one drop to be applied to the affected eye twice a day had the date it was opened recorded on the box. This showed that the medicine was being dispensed six days past the manufacturers recommended use by date. The Medication Administration Record (MAR) chart showed gaps in recording and Loperamide Hydrochloride 2mg tablets to be administered four times a day when necessary had not been signed for on five separate occasions to show whether or not the medication had been administered. The MAR also showed that Adcal tablets to be administered one tablet daily had been signed for on four separate occasions to indicate the tablet had been administered. The number of tablets remaining should have been 19. An audit showed 23 tablets therefore it was concluded that staff signed for medication that had not been given. An audit of Calcichew tablets prescribed for one resident showed that on four separate occasions the MAR had been signed to indicate medication had been given when it had not. The MAR chart belonging to a resident requiring Chloramphenicol eye drops to be administered in affected eyes four times a day had not been signed for nine days, therefore the home did not know whether the eye drops had been administered as prescribed. The records belonging to a resident assessed as being at risk of not having their nutritional needs met showed that a prescribed food supplement Fortisips was to be given once a day at 7:30pm. Daily monitoring records showed additional Fortisips were sometimes given in the morning. The last key inspection visit to the service found that designated staff administered Insulin but there was no documentary evidence to show whether the staff are appropriately trained and competent to carryout this task safely. The Manager reported that she had requested confirmation from the Community Nurse. At the time of writing the report this information had not been supplied. Throughout the duration of the inspection visit staff were observed treating residents with respect. Personal care was delivered in the privacy of the residents’ own room and toilet doors were closed when in use. There were generally regular and meaningful interaction and good relationships between the staff and the residents. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 16 Observations showed that staff interactions with residents requiring specialist dementia care were not engaging and some residents no longer had the capacity to understand what was being said. For example, one resident was asked repeatedly to wash their hands and one resident was asked to stop shouting clearly the residents did not understand what was being required of them. A number of residents spoken to said they were satisfied with the service and made positive comments about the staff. Comments noted include: my key worker is lovely and always available to help me the girls are very good I am very well looked after and if I need anything I only have to ask. Residents were well presented for example clothes were clean and well cared for and fingernails were clean and trimmed. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 17 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 and 15 Quality in this outcome area is adequate. Residents maintain contact with family and friends as they wish and can exercise choice and control over their lives. The home provides a well-balanced and nutritious diet but people with dementia are at risk of not having their nutritional needs met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an open visiting policy that takes into account the individual needs and wishes of residents. Three residents spoken to confirmed visiting was flexible and anyone visiting the home was made to feel welcome. Residents said they could choose where to receive visitors. Staff keep family members and or if appropriate their representatives up to date with any changes in their relative’s condition or care needs. One resident said she had been offered a key to her room and had declined reporting “did not see the need for a key.” The home is governed by the Trustees of the Bilton House charity and is actively supported by their congregations. Fund raising events such as Coffee Mornings are used to pay for trips out and in house entertainment. An annual Garden Party organised by the Churches is one of the summer social highlights. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 18 The home employs an activities organiser who arranges social and therapeutic activities for the benefit of residents. Information about planned activities was displayed on the ground floor reception area of the home. The residents spoken to who could express a view said they were satisfied with the activities made available to them. Information supplied by the home before the visit to the service showed that recreational activities include: Keep fit, quizzes, carpet bowls, coffee mornings and strawberry teas. Residents have the opportunity to visit local amenities, and pantomimes, garden centres and parks as well as places of particular interest such as Draycote Water and the Cotswolds. A central record of any planned group activities is not held. Information about residents’ participation in activities is held in the individuals’ personal record file. One resident spoken to said they enjoyed spending time doing crosswords and making birthday cards which she showed to the inspector. The resident reported that they used to enjoy gardening and when the weather was suitable, she would go into the garden in a wheelchair. Two staff members spoken to said some residents participated in chair aerobics every Monday and listen to the piano each Wednesday. The Manager talked about the activities programme and said that a number of residents enjoyed spending time potting plants and carrying out other gardening activities suited to their needs. Residents spoken said there was a visiting hairdresser and on request, the Activities Organiser provides a manicure, which they said, they enjoyed. Residents spoken to who were able to express a view said they could choose how and where to spend their time. The inspection found there were no restrictions on residents’ movements around the home. Observations during the inspection visit showed the activities organiser spending time with residents talking to them and offering some exotic fresh fruits. Residents enjoyed the experience and referred to the Activities Organiser by name. Information about past hobbies and interests were recorded on residents’ individual records but there was little or no evidence to show that residents requiring specialist dementia care are given opportunities to pursue past hobbies or interests or to engage in meaningful activities suited to their needs. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 19 For example, comments noted on residents’ personal record files included ‘looks happy when listening to music’ ‘relaxing’ and ‘watching TV.’ The Manager talked about a recent trip to Evesham when five residents from the Clarice Cooper wing went on a boat, had a roast beef lunch and then stopped for cream teas on the way home. More effort is needed to enable residents with dementia the opportunity to maintain their skills and mental agility. Consideration should be given to the introduction of tactile boards and other items that are safe to touch and which encourage finer dexterity skills. The absence of stimulation on the Clarice Cooper wing fails to engage residents who appear to spend long periods with little or nothing to occupy them. Services of worship are an important part of the Christian ethos of the home. Members of local Churches provide a Sunday service and what is known as the Tuesday morning Fellowship. Residents can choose whether to join in. A voluntary Chaplain regularly visits the home and residents enjoy visits by local schools to sing carols at Christmas and hymns at Easter. A visit to the kitchen found food storage and food preparation areas clean and well managed. Store cupboards held a wide range of provisions including fresh fruit. Four week’s menus were read and showed that a varied and nutritious diet with alternatives was provided. There are two dining areas one in the main part of the home and one on the Clarice Cooper wing. Most residents have lunch in one of the two designated dining areas and some remain in their rooms for meals. The dining area in the main part of the home provides an attractive and homely environment for residents to have their meals. While the Clarice Cooper wing was found to be somewhat sparse and did not have the same homely feel. It is recognised that people with dementia may not benefit from having a tablecloth on the dining table, or access to napkins, cutlery and condiments as this may further enhance any confusion, but the care provided must be person centred and reflect the individuals needs. The practice of serving cold drinks in plastic beakers is considered institutional and should be discouraged in favour of a more person centred approach that takes into account any potential risks to either the resident or to others. On the day of the inspection visit and in the absence of a designated cook, one of the assistant Managers prepared the meals. Residents were offered cottage pie or cheese and onion pasty served with brussel sprouts, cauliflower, new Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 20 potatoes and gravy. Followed by gateau or fresh fruit salad. One resident requested tomato soup and crackers, which were provided. Observations earlier in the day showed that residents were offered alternatives and the details were given to the kitchen so that the cook could be sure individual needs and preferences could be catered for. The cook talked about the dietary needs of residents and was aware of the needs of residents with diabetes and those assessed as requiring a soft diet. Meals were transported from the kitchen to the dining areas in a hot trolley and vegetable dishes placed on the tables so that residents could see what was available and where appropriate could help themselves. On the Clarice Cooper wing, residents were shown alternatives and those who were able to indicate a preference were encouraged to do so. Staff were available to provide the support residents needed to eat their food. Staff on the Clarice Cooper wing sat with the residents and had a meal. Support for residents was provided in a kind and respectful manner and residents were able to eat their food at a pace suited to their individual needs and abilities. Observations at a mealtime on the Clarice cooper wing raised concerns that a resident’s nutritional needs may not be being met. The resident was given their main meal at 12:55 and only one hour after they were seen eating their breakfast (porridge) at 11:55. People requiring specialist dementia care should be offered regular snacks and meals should be offered at appropriate intervals. The resident’s care plan and daily monitoring records did not provide sufficient information about the resident’s daily routines for staff to know whether nutritional needs were being met. For example, the time the resident went to bed the night before, whether they had a snack meal before retiring and what time they had their last meal. On the day of the inspection visit apart from some fresh fruit, and a biscuit with the mid-morning hot drink snack meals were not readily available to residents requiring specialist dementia care. A number of residents spoken to reported that they were satisfied with the food, which was varied and plentiful. Comments noted include: The food is beautiful we are always told what is on the menu and asked what we would like I like some cooks better than others Residents said they had three meals each day and one of which was cooked. One resident said she had biscuits with a hot drink in the evening. Two staff members reported that the food supplied by the home was of a good quality and there were no restrictions when ordering provisions. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. Residents have access to the information they may need to complain but the absence of information about the local arrangements for investigating allegations of possible abuse is unsafe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy and procedure and information about how to complain is displayed in a prominent position in the home and included in the Service User Guide. In response to shortfalls identified during the last visit to the service, complaints’ records were available and open to inspection. The records held no complaints since November 2005 and no complaints have been made to the commission. Three residents spoken to said they had not had cause to complain or would do so if dissatisfied with any aspect of the service. One resident said, theres nothing to complain about here. The home has a policy and procedure for the prevention and management of abuse that includes ‘Whistle blowing’. The policy and procedure was read and showed that information about the local arrangements for reporting and investigating allegations of possible abuse was not included. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 22 The Manager talked about how she would respond and investigate allegations of possible abuse but was not fully familiar with the local arrangements for the reporting and investigation of allegations of possible abuse. The absence of information and guidance about agreed local protocols that involve other agencies such as Social Services place vulnerable people at risk. Any investigation carried out in isolation may also hinder the process and could result in evidence being contaminated. Two staff members spoken to were aware of what actions may constitute abuse and had attended training to recognise signs and symptoms. The staff would report any concerns to the Manager. Residents reported they were treated well and had not had cause for concern. One resident said “I would soon say something if I thought we were not being treated properly.” Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 23 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): 19,20,21,22,23, 24,25 and 26 Quality in this outcome area is good. Residents’ benefit from living in a clean, safe and well maintained environment and where specialist equipment is available and use to maximise independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Opportunity was taken to tour the premises and found the environment was well maintained and all areas of the home seen were generally clean and free of odours. There was an odour on the Clarice Cooper wing and the floor was found to be sticky. The home has a programme of maintenance and refurbishment and plans are underway to refurbish the kitchen and dining room, redecorate the Clarice Cooper Wing and have new carpets fitted in the main corridor and staircase. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 24 Three residents spoken to stated that they were happy with their rooms, which they were encouraged to personalise. One resident said she had brought some small items of furniture into the home with her. Observations in the rooms of the residents’ case tracked showed that the environment was suited to their needs and they had the equipment they were assessed as needing. The rooms were clean and bright and held personal items such as photographs, plants and ornaments. A number of residents had their own telephone, radio and television. The laundry was well-organised and blue bags used to hold soiled items so that dirty and clean washing was kept separate to prevent risk of infection. The laundry was equipped with three washing machines two dryers and a sluice sink. Disposable gloves were readily available and used by staff handling soiled linen and when undertaking personal care tasks. Visitors and staff entering the home are encouraged to use a hand wash before entering the home and so reduce the risk of any infection being brought into the home. The home is spacious and comfortable and adaptations and equipment were readily available to meet the assessed needs of residents and included handrails fitted along corridors, grab rails and raised toilet seats. Residents have a choice of bathing facilities both assisted and unassisted and a number of toilets are strategically placed around the home. The care plan of one resident case tracked showed the resident was at risk of developing pressure sores. Action taken to reduce the risk included the provision of a pressure relieving mattress and chair cushion. Observations in the residents room showed that a pressure-relieving mattress (nimbus 3) was being used and observations in the dining room showed the resident used a pressure-relieving cushion. Two residents’ visited in their room were found to have safe access to a call alarm and sufficient space to move around their room safely. The call alarm was activated and staff were quick to respond. Residents have safe access to attractive and very well maintained mature gardens that provide sufficient seating to enable a number of people to spend time in the garden and a path around the garden enables residents to have some fresh air and a walk around the garden. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. Residents’ benefit from having their needs met by sufficient numbers of experienced and qualified staff. The absence of rigorous staff recruitment policies and procedures may pose a risk to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection visit the Manager reported there were 32 residents and a staff complement comprising of a Health and Safety and Administration Manager, Assistant Administrator, three Assistant Managers, seven Team Leaders, 22 Carers and a further seven bank Carers who provide cover during any staff absence. There are two Cooks, three Kitchen Assistants, Laundry Person, Maintenance Person, Accounts Assistant, Activities Organiser and eight Domestic Assistants plus one vacancy to be filled. Examination of four weeks staff rotas showed sufficient numbers of experience staff available to meet the needs of residents. For example, in the mornings and evenings, there were five Carers and a Team Leader and at night three Carers including a Team Leader. The rotas showed high numbers of staff sickness absence. For example, four Carers were absent on the same day and the vacant hours covered by bank staff. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 26 The number of staff on duty at the time of the visit corresponded with the number on the rotas. There were five Carers and an Assistant Manager on duty during the day and evening. The night rota showed there were three night Carers including a Team Leader. Comments from residents spoken to about the availability of staff varied. For example, three residents felt there were always sufficient numbers of staff available, one resident said they thought there should be more staff and one said she would like more staff but felt the home was generally sufficiently staffed. Observations throughout the inspection showed that staff were generally available when residents’ needed them. Two staff spoken with said the home did not use agency staff as there was sufficient staff employed to cover any gaps in the rotas. Information supplied by the home showed that 12 of the 29 Carers were qualified to NVQ level 2 or equivalent and that a further four were working towards achieving the award. Six Carers were being enrolled and the Domestic Assistants have enrolled for an NVQ relevant to their role. Examination of staff records and information supplied by the Manager showed that training undertaken since the last key inspection included Manual Handling, First Aid, Health and Safety, Infection Control and Food Hygiene. Training in specialist dementia care is provided and three staff attended a fourday dementia care course. Further training is planned for later this year. The staff files of two recently appointed workers showed they have an induction which is linked to NVQ units and requires staff to complete a learning log. The induction includes shadowing an experienced worker until the new worker is considered as competent. Examination of the staff rota confirmed this occurred and showed that new workers are supernumerary and not included in the number of staff on duty. One staff member spoken with confirmed they had received induction training and had worked alongside an experience staff member until they felt confident. The staff member said residents were well cared for. The personnel files belonging to the two most recently appointed staff were examined and showed that although the outcome of a Criminal Record Bureau disclosure and checks made against the Protection of Vulnerable (PoVA) register were secured before the person was confirmed in post a number of shortfalls in the recruitment process were identified. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 27 A written reference had been secured from the most recent employer of a person employed by the home on March 25th 2007. The written reference was not received until April 24th 2007. The Manager reported that she had accepted a verbal reference on April 2nd 2007. Records showed that evidence of identification had not been secured for the second worker. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 28 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): 31,33,35,36 and 38 Quality in this outcome area is adequate. The home is generally well run but shortfalls in health and safety management do not promote residents’ safety. Staff are supervised and quality monitoring is taken seriously. This judgement has been made using available evidence including a visit to this service. 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 and hopes to sign up for the Registered Manager’s Award. Most of the residents spoken to knew the Manager and felt able to approach her with any issues. One resident said, shes very nice and will always listen. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 29 Staff benefit from a range of health and safety-training details of which have been included under the Staffing outcome group of the report. The inspection found that some aspects of health and safety are not always well managed and a number of shortfalls identified during the inspection visit have been included in the report. Previous shortfalls when the management of records was found not to be of a good standard have generally been addressed with the improvements in care planning and monitoring. However, some of the documentation requested for the inspection was not available. For example, hot water temperature monitoring records for the bathroom downstairs where the water was found to be running in excess of 43°C. At the time of writing the report, the information had been supplied and showed that a representative from Warwickshire Fire and Rescue Service had visited the service and after inspection left a notice of Fire Safety Deficiencies. 1. Staff training to be carried out and recorded in the logbook. 2. Emergency plan to be formulated and made known to all staff. 3. The Fire Risk Assessment to be reviewed when necessary. Other records supplied showed temperature monitoring of water outlets by outside contractors take place and any action identified as being necessary is taken to ensure the continued safety of residents. A copy of the risk assessment for Legionella carried out in September 2006 was also supplied. Staff hygiene practices have improved and staff were observed wearing protective clothing when entering the kitchen or involved in food preparation tasks. Quality assurance monitoring is taken seriously and questionnaires are distributed to residents and their relatives or representatives each year. The Manager talked about the processes used to gather information about the quality of the service, which include residents meetings facilitated by the Manager. Two residents reported they were aware of the meetings and had on occasion attended. Minutes of the meetings were held and open to inspection. The agenda items are recorded on the minutes, which are agreed by residents and include, outings and entertainments. The names of those present were not recorded. The outcome of an audit of questionnaires sent to residents in May 2007 showed general satisfaction. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 30 Following the inspection visit to the service and in response to the draft inspection report the management team reported that quality surveys had now been distributed to relatives or residents representatives. Regular monthly visits by the Registered Person or their representatives to monitor the service are now being implemented as required by the Care Homes Regulations 2001. Reports of the visits are held and were available for inspection. Three staff spoken to said they had supervision and appraisal. Documentation supplied by the Manager confirmed this occurred. We obtain information before inspections. This information includes confirmation that all necessary policies and procedures are in place and are upto-date. These are not inspected on the day but the information is used to help form a judgment as to whether the home has the correct policies to keep residents’ safe. Information supplied by the home showed three residents maintain their own benefit book and handled their own financial affairs and 17 were subject to Power of Attorney orders. Three residents spoken to said they had deposited money at the home for safekeeping and could withdraw their money when they chose. A small amount of money is held at the home and the rest is held in a no interest bank account. Records of individual financial transactions were held on the homes computer and were seen. The home operates a system that requires the home to pay for services provided for residents such as hairdresser and chiropody and then the money is recovered from residents’ accounts. The hairdresser supplies the home with a receipt that includes the names of the residents who have used the service and the amounts owed. Individual receipts are not secured and given to residents to confirm payment for hairdressing, chiropody services, newspapers or magazines purchased on behalf their behalf. The Inspector was informed that all financial records are regularly audited to make sure they are managed appropriately and there are no discrepancies. The residents spoken to said they were satisfied with the service provided. Information and documentation such as the updated fire risk assessment and hot water temperature monitoring records must be readily available and open to inspection so that we are able to determine compliance. Information supplied by the home showed that the most recent fire drill took place on March 12th 2007 and that service checks on the emergency lighting, the passenger lift, the electrical wiring and central heating system have all taken place this year. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 31 The fire alarm is tested weekly and further fire prevention training is planned for July 2007. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 32 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 3 X 2 Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 33 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 OP7 Regulation 15 Requirement Care plans must reflect all the residents’ care needs and give clear and concise guidance to the staff. Any changes in need identified during reviews much be reflected in the care plans and there is clear evidence that changes are made to the care provided. Daily records must include evidence of monitoring and recording of how individual care needs are being met. So that staff and residents know what has been agreed and understand how needs are to be met. So that the staff are aware of what is required and residents can be confident, their needs can be met. Timescale of 30/11/06 not met Timescale for action 15/06/07 Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 34 2. OP8 13(4)(c) Risk assessments must be carried out for any activity that may pose as a risk to the residents. Paying particular attention to the use of bed rails and ensuring: • A detailed assessment has been carried out by someone who is appropriately qualified and trained • Adequate training has been undertaken to assess the risks to the bed user • Bed rails are identified as being compatible with the bed and must be fitted properly • All appropriate health and safety checks are carried out to include a regular maintenance schedule to check wear on the bed rails. So that the home can be sure, residents are not placed at risk of falls or entrapment. The outcome of any risk assessments must be used to inform care planning. So that any risks identified are minimised and so that staff adopt safe working practices and residents, have confidence in the environment. Medication such as eye drops must not be administered after the manufacturer’s use by date. So that residents receive their medication as prescribed and are not placed at risk of harm. Written confirmation that designated staff are appropriately trained to administer insulin must be obtained and a copy sent to the commission so that the home can be sure residents have insulin administered by staff who DS0000004210.V338324.R01.S.doc 13/07/07 3. OP9 13(2) 15/06/07 4. OP9 13(2) 15/06/07 Bilton House Version 5.2 Page 35 are appropriately trained. 5. OP9 13(2) Timescale of 30/04/06 not met Suitable arrangements must be made for the safe storage of residents’ medication so that residents have confidence in the environment and their health and welfare is promoted and maintained. 15/06/07 6. OP9 13(2) 7. OP9 13(2) 8. OP9 13(2) Timescale of 30/04/06 not met Risk assessments must be 14/07/07 recorded for residents who selfmedicate their own medication so that the home can be sure practices are safe and residents are not at risk of not having their health care needs met. The home must install a quality 14/07/07 assurance system to assess staff competence in medicine management and take appropriate action if staff fail to administer medicines in a safe and accurate way. The right medicine must be 15/06/07 administered to the right person at the right time and dose and records must reflect practice to ensure that all the medicines are administered as prescribed. Timescale of 30/04/06 not met Action must be taken to make sure that residents are not left for long periods without being offered a snack meal so that the home can be sure individual nutritional needs are being met. Sufficient information must be secured to determine the fitness of potential employees before they begin working at the care home. This must include two written references, including where applicable, a reference relating to the person’s last DS0000004210.V338324.R01.S.doc 9. OP15 12 13/07/07 10. OP29 19 Schedule 2 15/06/07 Bilton House Version 5.2 Page 36 period of employment, which involved work with vulnerable adults of not less than three months duration and evidence of identification. Staff not recruited through a robust procedure place residents at risk of harm. Timescale of 30/04/06 not met 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 OP7 Good Practice Recommendations Work to develop and improve the range of information held on care plans should continue so that the home can be sure the people using the service have their needs met. Preferred daily routines should be included on care plans especially for those residents with dementia so that they have some structure and continuity in their daily lives. Records of weight monitoring should be recorded in either Imperial or Metric so that any changes are easily identified. Daily monitoring records should include details of the care provided, any observations and the time the entry was made so that the home can be sure needs are being met. Interactions with residents should be meaningful and engaging so that residents feel valued and are given the opportunity to maintain cognition. A record of all group activities provided by the home should be held and used to monitor the quality and range of the service being provided so that the home can be sure individual needs are being met. This should include any activities provided to meet the needs of residents with dementia. Residents should be given opportunity to engage in meaningful activities appropriate to their needs. Bilton House DS0000004210.V338324.R01.S.doc Version 5.2 Page 37 2. OP8 3. OP12 Suitable signage should be displayed around the home to assist residents with orientation and promote independence and autonomy. Consideration should be given to the introduction of tactile boards and other items that are safe to touch and which encourage finer dexterity skills. Serving cold drinks in coloured plastic beakers is considered institutional and should be discouraged in favour of a more person centred approach that also takes into account any potential risks to either the resident or to others. A book to record comments, compliments and any informal complaints should be made available in the home and used to monitor the quality of the service and to demonstrate that all issues are taken seriously and responded to appropriately. A copy of the local arrangements for investigating any allegations of abuse should be held and used to inform practices. So that residents are protected and the home can be sure that, any investigation is carried out in accordance with the local arrangements for safeguarding vulnerable adults. The Clarice Cooper wing should be clean and maintained to the same good standards as other areas of the home. More staff should be trained in NVQ level 2 or equivalent so that residents benefit from having their needs met by suitably qualified staff. The views of other stakeholders such as GPs community nurses and other health and social care professionals should be sought during the annual quality review process and feedback used to further develop the service. The home should identify a strategy for responding to any shortfalls to guarantee continued service satisfaction. To place value on residents’ meetings the names of those present should be included in the minutes. The names of those in attendance at residents meetings should be recorded on the minutes so that a record of attendance is held and the home can be sure residents’ receive a copy of the minutes and other residents not in attendance can encouraged to participate. Individual receipts should be retained and held on the residents file for all services or products purchased on their behalf. DS0000004210.V338324.R01.S.doc Version 5.2 Page 38 4. OP15 5. OP16 6. OP18 7. 8. 9. OP25 OP30 OP33 10. OP35 Bilton House Commission for Social Care Inspection West Midlands Regional 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. 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