Inspection on 03/11/06 for Bilton House

This inspection was carried out on 3rd November 2006.

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

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

Other inspections for this house

Bilton House 10/02/09

Bilton House 12/12/08

Bilton House 10/12/07

Bilton House 14/06/07

Bilton House 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 3rd November 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bilton House DS0000004210.V315506.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.V315506.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.V315506.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st March 2006 Brief Description of the Service: Bilton House is a residential care home with a Christian ethos and is governed by a board of trustees from the Free Churches. 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 Clarence Cooper Unit accommodates eight residents with a diagnosis of dementia, this is referred to as the specialist dementia care unit 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 Clarence Cooper Unit has its own secure gardens but there is also a large well-maintained garden with a footpath, which residents can utilise from the main building. All rooms in the main building have ensuite showers and toilets. The rooms in the Clarence Cooper unit have ensuite toilets. There are 32 rooms in all but the home have used one of the larger bedrooms as a double hence the registration for 33. There are five communal lounges plus large corridor areas, which have seating and two dining areas one of which is in Clarence Cooper. At the time of the inspection visit the fees are based on dependency levels and are charged in the range £373.00 - £531.00 per week and payable in advance by either cheque, direct debit 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.V315506.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. In terms of the context for the inspection, it should be noted that throughout the report, residents represents those who are being cared for and the Home refers to Bilton House. Where reference is made to the standards and the regulations this means the National Minimum Standards for Care Homes for Older People and The Care Homes Regulations 2001, respectively. This was a key unannounced inspection visit and took place on Friday November 3rd 2006, commencing at 09.00am and concluding at 6.30pm. A key inspection addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. The inspector had the opportunity to meet most of the residents and talked to three of them about their experience of the home. The residents were able to express their opinion of the service they received to the inspector and conversation was held with other residents. A number of residents required specialist dementia care and it was difficult to talk to them, but observations enabled the inspector to gain a better understanding of how the needs of residents with dementia were being met. During the visit, records and documents were examined and an opportunity was taken to tour the premises. Five staff, the Treasurer, Manager and two visitors were spoken to and at the end of the inspection; feedback was given to the Manager and to the Chair and Treasurer of the Trustees of the Free Churches. 16 questionnaire surveys were sent to residents and their relatives. At the time of writing the report, nine residents and two relatives had responded. An audit of residents’ surveys showed satisfaction with the service provided. For example: residents know who to speak to if they are unhappy and the home is always fresh and clean. Staff listen and act on what residents say and are usually available when residents’ need them. A number of comments about the staffing arrangements were made and include: “Often short staffed.” I am happy in this home. Attention to me is good. I admire how the helpers and domestics keep going as there is a great shortage of staff but the work Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 6 has to be done by those who turn up. The girls are very exhausted at the end of their shift.” An audit of relative’s/visitors surveys showed satisfaction with the overall care provided. They are kept informed of important matters affecting their family member and are consulted about their care if their relative is not able to make decisions. Relatives and visitors are made to feel welcome and can visit their relative or friend in private. Since the last inspection on March 1st 2006, there have not been any complaints or allegations of abuse made to the commission. Due to the absence of the home’s complaints records, we were unable to determine whether the home had received any complaints since the last inspection. The Manager confirmed there had not been any allegations of abuse. What the service does well: What has improved since the last inspection? Two communal lounges five bedrooms and one corridor had been redecorated and a number of external windows painted. New carpets had been fitted in five bedrooms and in the main communal lounge and new chairs and tables in an area known as the Garden Lounge. In response to shortfalls identified during the last inspection information held on staff rotas had been revised to include the role of the worker, the start and Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 7 finish times and the number of hours worked so that the home can be sure sufficient numbers of experienced and trained staff are on duty. A number of care plans had been revised to include how to address hearing impairments including how to manage hearing aids so that residents have effective hearing. Information on how to manage hearing aids was also displayed in the staff room. A nutritional assessment tool and monitoring records for use with residents whose nutritional needs were giving cause for concern had been introduced. In response to shortfalls identified during the last inspection, the dispensing Pharmacist has carried out an inspection of the arrangements for storing and administering medication. A policy and procedure had been implemented for residents who chose to manage their own medication to make sure this can be done safely. The home had introduced a system for reviewing at appropriate intervals the quality of care provided at the home. Questionnaires were used to seek the views and opinions of residents, their relatives and friends. Further work is required to extend the quality review process 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. What they could do better: Records of pre admission assessments must be held and used to develop individual care plans so that the home can be sure the individual needs of prospective residents can be met before they move into the home. Care plans must be in place for all residents and include details of how needs are to be met so that staff have the information they need to ensure residents are cared for safely and appropriately. Record keeping in the home is not always well managed and some of the records necessary to confirm compliance with the National Minimum Standards and Care Homes Regulations 2001 were not available. This includes, resident’s assessment records and staff competency records concerning the administration of insulin. To promote data protection and access to records the practice of recording details of resident’s personal care (bathing) in a communal book is inappropriate. Information about resident care must be held in the resident’s personal record file. To promote and maintain the health, safety and welfare of residents’ improvements are necessary in the way medication is managed, for example, Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 8 Medication Administration Records (MAR) must include the time medication is given and the signature of the person responsible. Staff must refer to the records when medication is being administered so that the home can be sure medication is administered safely and as prescribed. Staff must respond appropriately to any significant changes in residents’ weight so that the home can be sure residents’ nutritional needs are being m The practice at mealtimes of using tablecloths and of having napkins readily available in the main dining area of the home should be extended to include the Clarence Cooper unit so that resident on this unit also benefit from having a good standard of service. Action must be taken to make sure bathwater is provided at safe temperatures so that the home can be sure residents are not placed at risk of scalding. Staff rotas and observations indicate sufficient numbers of staff are on duty however, some residents’ feel there are insufficient numbers of staff available to meet their needs. The manager must look at the way staff are managed and deployed so that the home can be sure resources are used effectively for the benefit of residents. Staff rotas need to identify the names of staff working on the Clarence Cooper unit so that the home can be sure there are always sufficient numbers of experienced and qualified staff available to meet the needs of residents requiring specialist dementia care. Details of the complaints procedure must be displayed in the home so that residents and their relatives know whom to contact should they have any concerns. Records of complaints must be held and open to inspection so that the organisation can be sure complaints are taken seriously and are well managed. 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.V315506.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.V315506.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): 3,4 and 5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has developed a resident guide, which provides information about the service. The guide is available to residents in a standard format. Prospective residents have opportunity to visit the home before deciding whether to move in for a trial period. The home has received copies of the summary, and care plans, from those assessments carried out through care management arrangement for most of the residents. The service is unable to demonstrate how they have undertaken the assessment of those individuals who are self-funding. Standard 6 is not included in this judgement, as the home does not provide intermediate care. Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 11 EVIDENCE: The home has devised a resident guide, which includes the aims and objectives and information about the service. Applications to the home are made by either social services or privately if self-funding. Individuals referred by social services have a care management assessment carried out before moving into the home. All prospective residents move into the home for an agreed trial period of up to three months. Two residents spoken to were asked about their experience of moving into the home and said they had been given a brochure about the home and were offered a trial period before deciding whether to move into the home permanently. Private applications for admission are sometimes agreed without reference to a care needs assessment, or consideration of the skills, ability or knowledge of the staff that will be caring for them. For example, two of the three initial care needs assessments identified for case tracking were not available. The manager talked about the assessment process and said receipt of an application form is followed by a home visit to meet the prospective resident and to carry out a formal assessment of needs to determine whether the home is able to meet those needs. Once this information has been obtained it is presented to the Selection Committee for the home. Residents are selected in order of greatest need and those who are part of the Free Church have priority. The initial care needs assessment of one resident had been recorded but did not hold all the information necessary to determine whether the home could meet, the individual’s needs. For instance, details of the level of support needed to meet personal care needs and what aspect of daily life could be managed independently had not been included. Two residents spoken with confirmed the manager visited and talked to them about how their needs could be met. Residents said they were quite independent compared to other residents and did not need a lot of practical support or personal assistance. Both residents said they used to visit attend activities at the home and had been on a waiting list for three years. The manager talked about shortfalls in the home’s Statement of Purpose identified during the last inspection and said the document had not been revised. Bilton House DS0000004210.V315506.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 and10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The absence of care plans; detailed and accurate monitoring records and poor management of medication is unsafe and place residents at risk. Residents have access to community health care services are treated respectfully and have their right to privacy upheld. EVIDENCE: Only one out of the three residents identified for case had a care plan. A second care plan was started but was not complete. The range of information held on care plans varies and does not always provide staff with the information they need to meet residents care needs for example: • Care plan states, needs assistance with personal care” but failed to identify what was required or what aspect of the activity the resident DS0000004210.V315506.R01.S.doc Version 5.2 Page 13 Bilton House could carryout themselves and necessary for promoting confidence and encouraging independence. • Staff were asked to “encourage fluids” but records failed to inform staff of the amount and frequency. The absence of monitoring records means the home cannot be sure the resident’s nutritional needs were being met. A resident assessed as having a life limiting illness and being cared for in bed did not have a palliative care plan or risk assessments for the prevention of pressure sores and for the use of bed rails. The absence of risk assessments necessary for maintaining health and safety and informing care planning place the resident at risk of not having their care needs met. The manager talked about the role of the McMillan nurse who advises on pain relief and who had been asked to provide staff with a palliative care plan. A number of discrepancies in care planning were noted for example: A weekly monitoring sheet includes having meals liquidised and a dietary monitoring intake sheet showed the resident had been given cheese and crackers. Daily records failed to show how pressure area care was promoted and how continence was managed. A dietary intake-monitoring chart was introduced for a resident whose nutritional needs were giving cause for concern. Gaps in monitoring and recording include one occasion when there was no evidence the resident had been offered breakfast or lunch. Poor monitoring and recording is unsafe and place residents at risk of not having their nutritional needs met. Records show that although regular weight checks were carried out staff failed to acknowledge or respond to significant weight gain and loss. For example: records show that in one week one resident gained 10 pounds and a second resident lost nine pounds. Residents unable to use weighing scales had their body weight assessed by staff using a body mass index to assess whether nutritional needs are being met. In contrast, some recorded information was detailed and informative; for example, the care plan and risk assessment of a resident assessed as being at risk of choking advise staff that they must not leave until the resident has swallowed all her food and “to make sure the resident’s head is raised” before supporting the resident to eat her food. There was documentary evidence of consultation with a speech and language therapist and a revised moving and handling risk assessment to show needs had changed and the resident was now being cared for in bed. Care plan reviews take place but care plans are not always updated to reflect changing needs for example: a care plan includes the use of wheeled commode and states “may sit out in armchair” when in fact the resident was now being cared for in bed. Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 14 Staff spoken to were aware of the need to treat residents with respect and to consider dignity when delivering personal care. The home arranges for residents to enjoy the privacy of their own rooms. Residents were happy with the way that most staff deliver their care and respect their dignity. Comments from residents made directly to the inspector include: • • • • • The staff are wonderful we could not asked for better. Most of the staff are really good but there’s always the odd one that’s not so good. The staff are generally patient and kind I have no complaints. Can’t do better than Bilton House. “Staff always make sure the door is closed when they help me to wash and dress”. Daily records failed to show whether residents were being offered or having regular baths. Records showed that during a six week period one resident had only been offered bath once. This issue was discussed with the manager who said the home had a “bath book” that was used by staff to record when residents’ had a bath. The book was seen and confirmed this occurred and showed that inappropriate methods were used to record personal care. The manager must make sure records of personal care are held in accordance with Data Protection and other requirements such as Access to Records policies so that the home can be sure information is held safely and securely and is compliant. Residents had access to health care services that meet their assessed needs both within the home and in the local community. Some residents were able to choose their own GP and two residents spoken to said they had been able to retain their own GP after moving into the home. Risk management is used to encourage residents to keep and administer their own medications where this happens safe storage is provided. Two residents spoken to said consultations or health care treatments were carried out in the privacy of their own room. Examination of the storage, administration and handling of medication showed that medication was stored safely and securely and administered by suitably trained staff. Examination of the Medication Administration Records (MAR) identified a number of gaps in recording and administration for instance: one tablet from a course of Amoclaim tablets was left when the course should have been completed and on four separate occasions medication records had not been signed. Fucidin cream to be applied three times daily had also not been signed for therefore the home cannot be sure medication and treatments are being administered as prescribed. A number of medication records failed to identify the time medication was administered. The absence of accurate records is unsafe and place residents at risk. Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 15 Information held in one care plan included Prochlorperazine tablets prescribed to be given prn (when necessary) and advised staff of the circumstances of when this was to be given. Controlled medication is stored and recorded separately. The care plan of a resident prescribed Morphine oral solution 5-10mls required as directed states to be administered 20 minutes before personal care daily care records and MAR charts showed that personal care was provided before the medication was given therefore pain was not managed appropriately and medication not administered as prescribed. Two signatures were held confirming controlled medication had been administered. Observations at lunchtime found staff administering medication without crossreferencing the medication with the MAR charts therefore practices were unsafe. The inspector intervened and stopped the care worker from continuing until she the MAR charts had been collected from the office. Two staff spoken with said they always used the medication records when administering medication and confirmed they had received training in the safe handling of medicines. In response to shortfalls identified during the last inspection the medication, trolley had been cleaned but loose paracetamol tablets were left in the trolley so it was unclear as to who they were prescribed for. The inspector was told that a number of staff had been trained by the community nurse to administer insulin injections documentary evidence that staff are trained and competent to carry out this activity were not available. This shortfall was identified during the last inspection and remains outstanding. Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. The home has developed a system for displaying information and bringing attention to the community events and activities. Family and friends feel welcome and know they can visit the home at any time. Sufficient staff resources are provided to allow time for activities and stimulation but further work is required to make sure residents with dementia have access to the same opportunities as other residents in the home. EVIDENCE: The home has an open visiting policy that takes into account the individual needs and wishes of residents. Four residents and one visitor spoken to confirm visiting is flexible and visitors are made to feel welcome. Staff keep family members and representatives up to date with any changes in their relative’s condition or care needs. Visitors were observed visiting their relative in the privacy of their own room or in communal areas of the home. One resident spoken to said he had been given a key to his room and a key to the home so he was free to come and go as he pleased and was able to retain some degree of independence. Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 17 The home is governed by a Board of Trustees from the Free Churches and is actively supported by their congregations. Fund raising events such as Coffee Mornings are used to pay for the outings and entertainments. An annual Garden Party organised by the Churches is one of the summer social highlights. The home employs an activities organiser with responsibility for devising a programme of social and therapeutic activities for the benefit of residents. Four residents spoken to said they were satisfied with the activities available which include: Keep fit, pottery, art, crafts and visits to places of interest. On the day of the inspection, a number of residents accompanied by their families attended a bonfire party followed by a snack meal of hot and cold foods served in the main dining room. One resident spoken to said she had been involved in making the ‘Guy’ for the bonfire. Two residents spoken to said they enjoyed the activities and had spent the morning painting plates. Daily records were held of resident participation in activities. Three residents spoken to said they prefer to spend time in the privacy of their own rooms. All of the residents spoken to said they could choose how and where to spend their time. Two residents spoken to said they did not like the home’s policy of allowing residents with dementia the freedom to move around the home as they chose. The inspection found positive outcomes for most residents who said how much they enjoyed the social events and activities especially “the old time music hall” and in the summer visits to local shops and the museum, but for residents with dementia there was little evidence of positive outcomes. For example: The care plan and daily records of a resident with dementia failed to show how and where she spent her time and what suitable options were open to her in terms of daily life activities. Serious 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 environment on the Clarence Cooper unit lacked stimulation and failed to engage those residents with dementia, who spent long periods with little or nothing to occupy them. Staff training records show that a number of staff had attended a four-day training course in ‘dementia awareness’ and the manager said further training was planned. Three staff spoken with confirmed this occurred. Observations found staff responsive to the needs of residents and friendly interaction took place. For example, a carer was seen encouraging a resident to visit the toilet, this was done in a sensitive and caring manner. The activity was unhurried and carried out at a pace suited to the resident’s needs. Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 18 Services of worship are an important part of the Christian ethos of the home. A service every Sunday and the Tuesday morning Fellowship were led by members of the local Churches. Residents can choose to join in. A voluntary Chaplain makes regular visits to the home and residents enjoy visits by local schools to sing carols at Christmas and hymns at Easter. A tour of the premises found the kitchen was clean and well managed. Temperature records were held of the fridge, freezers and high risk cooked foods. The cook talked about the arrangements for cleaning the kitchen and said that although there was not a formal cleaning schedule in place all areas of the kitchen were routinely cleaned every day. Store cupboards held a range of provisions including fresh fruit. Four weeks menus were examined and found to provide a varied and nutritious diet that offered alternatives. Snacks meals were readily available in the home more especially for those residents with dementia so that they could have something to eat when they chose. One resident spoken to said she had recently celebrated her birthday and the kitchen staff had supplied a birthday cake. The home has two dining areas one in the main part of the home and one on the Clarence Cooper unit. Most residents have lunch in one of the designated dining areas, while others remain in their rooms. Observations at a mealtime found residents using the dining area in the main part of the home benefit from a having an attractive and homely environment in which to take their meals. Dining tables were attractively presented with tablecloths, napkins, cutlery and condiments. In contrast, the dining room on the Clarence Cooper unit lacked natural light and was not deemed homely; for example, dining tables were not set with tablecloths or napkins and residents were given a tabard to wear to protect their clothes. The environment and culture on the Clarence Cooper unit needs to be improved so that residents on this unit are not disadvantaged and have a homely and comfortable environment that takes into account their individual needs and abilities. Meals are transported from the kitchen to the dining areas in a hot trolley, where on the Clarence Cooper unit meals are plated up by staff and in the main dining room residents help themselves to vegetables served in dishes on the dining tables. Residents were offered cod with parsley sauce or chicken pie, with potatoes, carrots and peas followed by chocolate sponge and custard or if preferred yoghurt. Observations showed staff were available to provide any assistance or support needed. Two residents in the Clarence Cooper unit needed assistance to eat their food. Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 19 Staff support was generally provided in an appropriate manner, for instance one carer sat next to a resident while assisting them to eat their food and was encouraging. Another carer remained standing and used a fork rather than a spoon to help the resident to eat their food. The practice of not sitting with residents could indicate a lack of respect and may affect the residents sense of self worth. Staff practices of using a fork rather than a spoon when assisting residents to eat their food without first carrying out a risk assessment is unsafe and place the resident at risk. Staff asked residents what they would like from the menu but choices for residents with dementia was limited because they were dependent on memory. Choice should be emphasised by showing residents the food or picture images to enable them to make choice in the moment rather than relying on memory. Three residents spoken to said the food was very good and there was always plenty of it. One resident said they were offered a cooked breakfast and a snack and hot drink after tea. Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has a weak complaints procedure, which has shortfalls in its content regarding who to complain to, what can be expected to happen if a complaint is made and the timescale for a response. The complaints procedure is not displayed in the home and records of complaints not held. Staff demonstrate an awareness of the adult protection policy and procedure and know what immediate action to take and when and who to refer any incident on to. Residents and others associated with the home are satisfied with the service provision and feel safe and supported. EVIDENCE: The manager talked about the complaints procedure but was unable to locate a copy for the Inspector to read. Information about how to complain was not displayed in the home and records of complaints were not available and not therefore open to inspection. The manager said she thought there might have been one complaint made since the last inspection but could not be sure. Three residents spoken to were unaware of the complaints procedure but would raise any issues with the manager if dissatisfied with any aspect of the service. A copy of the complaints procedure must be displayed in the home so that residents, their relatives and representatives know who to contact. Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 21 A copy of the resident guide read after the visit to the home held some information about how to complain however complaints procedure requires revising to make clear complaints can be referred to the commission at any stage of the process and make clear that complaints will be responded to within a timescale no longer than 28 days. The home has a policy and procedure for the prevention and management of abuse that includes ‘Whistle blowing’. Staff attend adult protection training and those staff spoken to were aware of what actions may constitute abuse. Said they would report any concerns to the manager. Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 22 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. This judgement has been made using available evidence including a visit to this service. There is a choice of bathing facilities both assisted and unassisted, and there are a number of toilets strategically placed around the home. Residents have the choice to bring small personal items of furniture into the home. All the homes fixtures and fittings meet the needs of the residents and can be changed if their needs change. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in privacy or in their own rooms. The management has a good infection control policy and encourage staff to work to the homes policy to reduce the risk of infection. EVIDENCE: A tour of the premises found the environment was well maintained and all areas of the home seen were clean and free of offensive odours. Residents have a choice of several seating areas and the home is very spacious. Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 23 All room sizes complied with National Minimum Standards (NMS). Residents were happy with their rooms and confirmed they were cleaned regularly. There were four communal bathrooms (two on each floor) four communal toilets plus all bedrooms had their own toilets. The laundry was well organised and blue bags were used to hold soiled items so that dirty and clean washing was kept separate to prevent risk of infection. There were three washing machines two dryers and a sluice sink. One of the washing machines was new and included a sluice facility. Staff had access to disposable gloves, which they used when handling soiled linen or attending to personal care tasks. Other measures taken to reduce the risk of infection or cross contamination include staff use of an alcohol based hand cleaner and liquid soap and paper towels available in the laundry, bathrooms and toilets. Information provided by the manager before the inspection visit confirm staff attend training in infection control. Two residents and one relative were asked about the quality of the laundry service. Residents said they were satisfied with the service, which was described as generally reliable. The relative said she was always pleased with her relative’s appearance and had no complaints. Observations found residents clean and well presented. The rooms of the three residents identified the case tracking were viewed and were all comfortable and homely and had been personalised with photographs, plants, ornaments and small items of furniture. One resident showed the inspector the bed linen purchased by the resident to match the new carpet she had chosen and the cost of which had been met by the home. This is to be commended. Two residents had their own phone and a secure storage space in which to hold personal items such as medication or personal papers. Oneroom had an ensuite with a shower. Grab rails are available and used to promote independence and maintain the resident’s health and safety. The room of a resident assessed as requiring assistance with moving and handling and at risk of developing pressure sores had a hospital type bed equipped with a variable height adjuster and special mattress necessary to assist staff with moving and handling and to help reduce the risk of pressure sores. Adaptations and equipment were available to meet the assessed needs of residents and include handrails fitted along corridors, grab rails and raised seats in the toilets, access ramps leading into the garden. There was a hoist, a passenger lift and a staff call system. Observations in one-bedroom showed an extension lead had been attached to the call alarm so that the resident could call for staff assistance from anywhere in the room. Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 24 Comments received on a questionnaire survey from a resident include when Im sitting in my armchair I cant reach the call alarm. This issue was raised with the manager who is to consult residents and staff and make sure all residents have easy and safe access to the staff call alarm. Ramps provide safe and easy access to the gardens, which are spacious and well managed. Bilton House DS0000004210.V315506.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. This judgement has been made using available evidence including a visit to this service. The home recognises the importance of training, and delivers where possible a programme that meets any statutory requirements. Residents have confidence in the staff that care for them but care needs are not always met in a timely manner. Staff recruitment procedures do not always promote the safety of residents. EVIDENCE: At the time of the inspection there were 32 residents and a staff compliment comprising of a registered manager, health and safety and administration manager, three assistant managers, six care officers, 28 care assistants, six domestic assistants, two cooks, a laundry assistant, two kitchen assistants, a maintenance person, wages clerk and an activities organiser. On the day of the inspection the home was staffed with five care assistants’ one assistant manager, two domestics, a cook, kitchen assistant, laundry person and activities organiser. Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 26 Examination of four weeks staff rotas appeared to show there were sufficient numbers of experienced staff available to meet the needs of residents for example in the mornings and evenings there were five carers plus a senior on duty and three carers at night one of which was a senior. The manager said there had been a number of staff vacancies and subject to the outcome of Criminal Record Bureau (CRB) disclosures and checks made against the Protection of Vulnerable Adults (PoVA) register three new workers would be taking up their roles and responsibilities. Records showed that any shortfalls in staffing were filled by four regular relief carers or if necessary agency staff. One relative spoken to said there were generally sufficient numbers of staff available, but staff absence sometimes affected the service. Throughout the inspection, a number of residents were asked for their views on staffing and most said they thought the home was often “short of staff”. Comments made directly to the inspector include: “ they are so busy I don’t like to bother them” and “there doesn’t seem to be enough to go around.” Comments noted on questionnaire surveys include: “I admire how the helpers and domestics keep going as there is a great shortage of staff that the work has to be done by those who turn up.” “The girls are very exhausted at the end of their shift. “Sometimes are so busy owing to staff shortage they cannot come at once as looking after someone else and often short staffed. Observations found staff responded to residents who had their needs attended to in a timely manner. The manager must look at how staff are managed and deployed and re assess the individual needs of residents so that the home can be sure sufficient resources are available and used effectively for the satisfaction of residents. As residents feel there are insufficient numbers of staff available to meet their needs, the timescale for compliance identified during the last inspection is therefore not met. Staff records show that staff have access to a wide range of training and development opportunities and include: diabetes; management of incontinence; falls prevention and therapeutic activities. Carers also attend a four-day dementia awareness-course and a small number have attended training in mental health. 14 of the 30 care staff have completed a National Vocational Qualification (NVQ) in care or equivalent and a further five are working towards achieving the Award. Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 27 The files of two recently appointed staff were selected for closer examination. The staff induction records were not available for inspection as the new worker holds them until the induction has been completed when the record is held on the worker’s personnel file. Therefore, a third staff file was randomly selected and confirm induction training in line with the National Training Organisation (NTO) standards takes place. One carer spoken to said the induction of new workers includes a range of health and safety training such as moving and handling and working along side an experienced carer for an agreed period. The personnel files of two recently appointed staff were examined and found to contain most of the information and pre-employment checks necessary to determine fitness such as, previous work history, Criminal Record Bureau (CRB) disclosures and checks made against the Protection of Vulnerable Adults register (PoVA). The manager talked about the staff recruitment process and of the difficulties experienced in securing references from the prospective employees’ most recent employer. This was confirmed by the absence of information held on the two files examined for instance the most recent employer of one worker failed to respond to a reference request and the home managed to secure a reference from another previous employer. The manager said a reference request from a care home had not been forthcoming resulting in a reference being obtained from someone the worker used to ‘baby sit’ for. Failure by a care home to respond appropriately to requests for employment references is to be raised by the inspector with the manager of the named care home. The manager was advised to inform the commission of any difficulties when trying to secure employment references from care homes. In response to shortfalls in the staff, recruitment processes identified during the last inspection although limited some interview notes were held on the applicant’s personnel file. Bilton House DS0000004210.V315506.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): 31,33,35,37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is qualified and has the necessary experience to run the home. Residents have the opportunity to manage their own money if they wish, and some facilities are provided to help keep it safe. Where the home manages money on residents’ behalf systems are in place to safeguard residents’ finances. There is a system in place for reviewing and monitoring the service. Health and safety policies and procedures are in place to protect residents but shortfalls identified in staff practices may place residents at risk. Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 29 EVIDENCE: The manager is experienced and holds a Higher National Diploma in Gerontology and a City and Guilds Advance Management in Care. She has recently completed a certificate in dementia care and demonstrated a commitment to further training including the Registered Manager’s Award (RMA). Most of the residents spoken to knew the manager and said she was available and approachable. Two relatives spoken to said the home is well managed and welcoming. Three staff spoken to said residents were well cared for and they felt they could discuss any work related issues with the manager who was always available. Shortfalls in the management of records identified during the last inspection remain outstanding for instance some care planning and recording was not of a good standard, documentation required for inspection was not available and some records were not held and maintained in accordance with the Data Protection Act 1998 and other requirements such as access to records. (Referred to in the Health and Personal care and Complaints and Protection sections of this report). In response to shortfalls identified during the last inspection, a quality assurance process was implemented earlier this year and includes seeking the views of residents and their relatives or representatives. The manager talked about the quality assurance process that includes an audit of responses and a copy of the findings. The outcome of the quality audit was read and shows a high level of service satisfaction. The home should identify a strategy for responding to any shortfalls to guarantee continued service satisfaction. The inspector read the questionnaire and found the format unsuitable for residents with dementia. Health and social care professionals and other stakeholders should be consulted and their views obtained and used to further develop the service. Regular visits by the registered person or their representative to monitor the service were not being implemented as required by the Care Home Regulations 2001. This shortfall must be addressed so that we can be sure the service is being regularly monitored and the health, safety and welfare of residents protected. There are a range of health and safety policies and procedures and an administration manager who is responsible for health and safety matters. Health and safety training is provided for staff and includes first aid and the Control of Substances Hazardous to Health (CoSHHE). Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 30 In response to shortfalls identified during the last inspection, the manager said arrangements for an electrical wiring check had been made and a risk assessment for Legionella carried out. Checks had been carried out on electrical portable appliances and records showed fire drills take place twice yearly and the fire alarms tested weekly. We obtain information before inspections. The 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 and staff safe. Information supplied by the home before the inspection showed that none of the residents managed their own financial affairs. Two residents spoken with said family members supported them. A number of residents or their relatives deposit money at the home for safekeeping and for use for services or items purchased on the residents’ behalf such as chiropody or toiletries. A small amount of money is held at the home and the rest held at the bank. Records of all financial transactions were held on the home’s computer and showed details of individual accounts. Residents sign to confirm any withdrawals and three monthly statements issued advising residents or their relatives of any financial transactions and the balance of their account. One account seen was overdrawn, the treasurer said this sometimes happens and deposits are made upon receipt of the quarterly statement. Individual receipts for items purchased on behalf of residents are held apart from monies paid to the hairdresser. In response, the treasurer said he would make sure individual receipts for hairdressing were secured. Records of monies held at the home are in place and showed any expenditure or resident withdrawals. The arrangements for managing residents finances provide positive outcomes for residents who know their finances are protected and are readily available when requested. The following shortfalls relating to the health and safety of residents were identified: • • Although pre-set valves were fitted to provide hot water close to 43ºC the water in a bathroom on, the ground floor was assessed as being above 43ºC and therefore place residents at risk of scalding. Staff routinely enter the kitchen without wearing protective clothing and therefore increase any risk of infection of cross contamination. The manager must ensure hot water temperatures are maintained within safe levels and suitable protective clothing made available and used by anyone entering food preparation areas so that the home can be sure residents are safe and their health protected. Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 31 In response to shortfalls identified during the last inspection a copy of the current Employers Liability Certificate was received by the commission and the door leading to the cleaning cupboard located near the Clarence Cooper unit was locked when not in use. Bilton House DS0000004210.V315506.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 X X 1 1 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 2 2 Bilton House DS0000004210.V315506.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 OP3 Regulation 14 (1) Requirement Resident assessment records must be available on file consistently to demonstrate assessments carried out. (Timescale of 30/04/06 not met). The Registered Person must ensure care plans are written and implemented for all residents. The Registered Person must ensure: the care plans reflect all the care needs of the residents and give clear and concise guidance to all the staff; there is clear evidence that the care plan is evaluated monthly and changes are made to prescribed care as required. daily records include evidence of monitoring and recording of how individual care needs have been met. Timescale for action 30/11/06 2. OP7 15 30/11/06 3. OP7 15 Schedule 3 30/11/06 Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 34 4. OP8 12,13,17 Sch3 The Registered Person must ensure nutritional monitoring records include details of food and fluid intake for those residents whose nutritional needs are giving cause for concern. The Registered Person must ensure that evidence of a service user experiencing significant weight gain or loss is acknowledged, investigated and responded to appropriately. The Registered Person must ensure that risk assessments are completed for all service users and where a risk is determined, a care plan must detail the actions to be taken by staff to minimise the risk. The Registered Person must arrange for the recording, handling, safe administration of medicines received into the care home. The Registered Person must obtain written confirmation that designated staff are appropriately trained to administer insulin. Timescale of 30/04/06 not met). The Registered Person must ensure social and therapeutic activities are suited to individual service user’s needs and capacities. The Registered Person must ensure service users are offered a diet suited to their assessed nutritional or health care needs. Care staff must not give solid foods to service users assessed as requiring a liquidised diet. 30/11/06 5. OP8 12 Schedule 3 30/11/06 6. OP9 13(2) 30/11/06 7. OP12 12(4)(b) 31/01/07 8. OP15 12(1) 30/11/06 Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 35 9. OP16 22 The Registered Person must ensure the complaints policy and procedure is revised to include all the information listed in the Care Homes Regulations 2001 and a copy displayed in a prominent position in the home. (Timescale of 30/04/06 not met) The Registered Person must ensure a record of all complaints about the operation of the care home, and the action taken in respect of any complaint held and open to inspection. The Registered Person must be able to demonstrate sufficient numbers of staff are on duty and provide records of which staff are working on the Clarence Cooper Unit. (Timescale of 30/04/06 not met) The Registered Person shall not employ a person to work at the care home unless full and satisfactory information is available in relation to him. 31/12/06 10. OP16 17(2) Schedule 4 (11) 31/12/06 11. OP27 18 17 31/12/06 12. OP29 19 Schedule 2 30/11/06 13. OP33 26 14. OP37 17 (Timescale of 30/04/06 not met) The Registered Person or 31/12/06 delegated person must visit the home monthly and write a report upon the conduct of the care home. A copy of this report must be available for inspection. The Registered Person must 31/12/06 ensure individual records and home records are secure, up to date and in good order and are constructed, maintained and used in accordance with the Data Protection Act 1998 and other statutory requirements. Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 36 15. OP38 12 The Registered Person must ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users and ensure hot water temperatures are monitored and temperature records held to make sure water runs at safe temperatures and service users not placed at risk of scalding. The Registered Person is to confirm a date for the Fire Risk Assessment for the home to be updated. (Timescale of 30/04/06 not met) The Registered Provider must ensure that all persons accessing or working in the kitchen area wear protective clothing. 30/11/06 13 23(5) Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 37 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 OP15 Good Practice Recommendations It is recommended that service users with dementia be shown alternatives at meal times so that they may make informed choices. Unless their risk assessment suggests otherwise service users being cared for on the Clarence Cooper unit should have their meals served in an equally attractive environment as that experienced by service users’ in the main dining room. Staff should sit with service users when assisting them to eat their food and a risk assessment should be carried to make sure it is safe to use a fork to assist service users with dementia to eat their food. 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. 2. OP33 Bilton House DS0000004210.V315506.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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.V315506.R01.S.doc Version 5.2 Page 39 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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