CARE HOMES FOR OLDER PEOPLE
Bishop`s Court Sefton Park Care Village Sefton Park Road Liverpool Merseyside L8 3SL Lead Inspector
Trish Thomas/Lorraine Farrar Unannounced Inspection 1 and 3 July 2008 20:30 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 Bishop`s Court DS0000059340.V367678.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. Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Bishop`s Court Address Sefton Park Care Village Sefton Park Road Liverpool Merseyside L8 3SL 0151 291 7800 0151 291 7801 bishopscourt@europeanwellcare.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) European Wellcare Homes Ltd Manager post vacant Care Home 41 Category(ies) of Dementia - over 65 years of age (41) registration, with number of places Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1 2 Three named people under 65 years old may be accommodated The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection One additional named resident requiring palliative care under the age of 65 years 14 April 2008 3 Date of last inspection Brief Description of the Service: Bishop’s Court is a care home which is situated in a busy suburb of Liverpool and is registered for forty-one people who have been assessed as having dementia. The home is owned by European Wellcare Homes Limited. The recently appointed manager is Judith Keane. The building is modern, purpose built and provides ground floor accommodation. Bishop’s Court has pleasant grounds, parking facilities and a courtyard garden. Residents have single bedrooms, twenty-two having ensuite facilities. The home is close to Liverpool city centre, to local shops and public amenities. The fees for Bishops Court start at £490.00 per week; hairdressing is charged for as an extra. Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is no stars. This means that people receive poor quality outcomes.
We (the commission) visited Bishop’s Court on 1 July 2008 and on 3 July 2008. Because this service has a quality rating of poor, this was the second key inspection this year, the last one being on 14 April 2008. During the inspection, we spoke with residents, a visitor and staff who were on duty. We spoke with the general manager and the recently appointed manager of Bishop’s Court. Because many of the people who live in Bishop’s Court are not able to give their opinions, we observed the way they were supported by staff in the dining room and lounges. We were accompanied on this visit by a pharmacist inspector. She looked at the way medication is managed in Bishop’s Court. We looked at the records kept in the home for staffing and health & safety and we read care files in detail to find out how people are cared for in Bishop’s Court. We checked on whether requirements we made during the last visit have been met. We also checked whether two legal notices (statutory requirement notices) that we served on 23 May 2008 with further requirements about care planning, restraint and recruitment, had been complied with. What the service does well: What has improved since the last inspection?
Requirements from the last visit have been met as follows. The statutory requirement notice dated 23 May 2008 with requirements about the use and recording of physical restraint: During our visit of 1 and 3 July 2008, we found no evidence that people living in the home had been physically
Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 6 restrained. The general manager of the home confirmed that staff who need it have received supervision and instruction to improve their skills and knowledge of each person’s right to freedom of movement within the home. Improvements have been made to the garden and people may now use this in safety as the flowerbeds and fountain have been fenced off. It is easy for people to get to the garden from the main corridor so they can benefit from getting outside more regularly. People have had continence assessments and there were enough continence pads in Bishop’s Court to meet people’s needs. In this way their dignity, comfort and welfare will be promoted. Improvements were observed in residents’ personal grooming and clothing. Action has been taken to replace clothing, which was mislaid in the shared laundry, as necessary. Bishop’s Court is to have its own laundry (which was being fitted out at the time of the visit) which should avoid items going missing and people wearing other people’s clothes when their own clothing is not returned to them. There are action plans in place to support people’s behaviour and best practice was observed in supporting a person who becomes agitated. In this way the person’s quality of life is improved and a more relaxed atmosphere is created, especially during meal times. A lot of work has been done to improve activities for people who live in Bishop’s Court. An activities co-ordinator has been employed and some people have enjoyed going out shopping and to a social club. Further action needs to be taken regarding activities, as there was no entertainment for people during the evening, and records of activities were not available during the visit. Since the new manager has been in post, there is one system for recording accidents so monitoring of trends and risk factors is easier and wherever possible, accidents will be avoided. There is better communication from staff of Bishop’s Court and incidents and accidents are being notified to CSCI, in accordance with the Care Homes Regulations. Recommendations from the last visit have been addressed as follows. A handbook, “A Guide for working with the elderly,” has been issued to staff. This gives them guidance on areas of their duties, such as promoting equality, safeguarding people and reporting complaints and suspected abuse, care of mobility aids, team working and supporting people who have dementia with their meals. In this way, staff have been given information on best practice so they can be consistent in their approach when supporting and giving care to the people who live at the home. Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 7 Senior staff have reviewed people’s experiences at meal times. There are now two sittings for meals in the dining room and the meals are more relaxed than observed during our previous visits. A number of orientation aids, which were removed when the home was decorated, have been replaced on doorways in the corridors, in bedrooms and in the dining room. In this way people will have a more interesting place to live in, and those who have difficulty finding their way around have visual aids to help them. A safe has been installed since the last visit, and the manager has made sure that there are official receipts for purchases made on behalf of people who live in Bishop’s Court. In this way, people will be protected through good finance management and their personal allowances will be secured. Repairs have been made to the thermostat since the last visit and the boilers were said to be working efficiently to provide warmth throughout the building. What they could do better:
It is important that anyone considering moving into Bishops Court, and their relatives, are given as much information as possible so that they can decide if the home will be suitable. The service user guide currently in use is a generic brochure, which is shared by a number of homes in the organisation. An up to date service user guide that is specific to Bishop’s Court should be provided and given to people before they move in so they know what the home provides. The assessments done by staff of Bishop’s Court before people move into the home need to cover the complete range of each person’s health, personal care and leisure needs and preferences. They should be reviewed regularly whilst the person is living in the home to make sure that any changes in their needs are identified and their care plan amended accordingly. We served a legal notice on 23 May 2008 on the providers, about care planning in Bishop’s Court. This included requirements to make sure that people were not placed at risk because their care plans were not accurate or complete. We found during this visit that care plans were in the process of being upgraded by staff. About half of them had been changed to a new format to give staff clearer guidance as to how to support people. This work needs to be finished, so that support plans for health care and personal care that also identify people’s social, emotional and cultural needs, are easy to access and follow for staff. In this way a complete and consistent approach to supporting people will be maintained. Shortfalls were identified in medication record keeping and in lack of a clear medication procedure for staff guidance. This needs to be dealt with. The times that medicines are given to people who live in the home need to be
Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 8 monitored to ensure medicines are given at the right and best times for people. Regular checks of controlled drugs handling should be carried out to ensure records are accurately completed and to reduce the risk of mishandling. Although some improvements had been made to conditions in the dining room at mealtimes, further improvements need to be made. For example, one member of staff was seen helping more than one person at a time with their food and another was seen picking up food in their fingers and placing it a resident’s mouth. We found that people’s complaints are listened to and acted upon. Senior staff have made referrals to the appropriate agencies, (such as police and/or social services) under safeguarding procedures. However, some staff have not yet received training on safeguarding adults to make sure they know how to protect people living in the home from abuse. The general manager told us this is progressing. As training records were not available, we have no evidence of how many staff had received the training. During our last visit in April 2008, we found that managers of Bishops Court had failed to follow rigorous recruitment procedures. Staff files did not contain the references and clearances needed to ensure they are of good character and are suitable to work in the home. We served a legal notice on 23 May2008 with requirements to make sure that all the necessary checks were carried out before staff start working in the home. At this visit, we found this legal notice had not been complied with. There was no evidence of a quality monitoring system in Bishops Court to make sure that residents’ wishes and feelings influence the way the home is run. It is recommended that an internal quality assurance system be established for Bishops Court. At our last inspection we made a requirement about the way the use of bedrails is managed. At this inspection we found that four of the bedrails posed a risk of entrapment of the person, through gaps between the bedrail and mattress. It is a matter of serious concern that the company failed to carry out regular checks on equipment they provide for people. Since the inspection, we have been informed that new bumpers have been fitted to the bedrails to cover the gaps and make the bedrails safe for people. We have repeated our requirement about this equipment and made a recommendation that staff receive training to make sure they know how to use bedrails safely. 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. Bishop`s Court DS0000059340.V367678.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 Bishop`s Court DS0000059340.V367678.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, 3 and 6 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. People have had their needs assessed and recorded before moving in to Bishop’s Court. However, these lack information and prospective residents have not been given up to date information to help them to decide whether this will make a suitable home. EVIDENCE: We found that there is no up to date service user guide for Bishop’s Court. This had been the case during our last visit when we were told there were plans to update this document. This has not been carried out so people considering moving into Bishop’s Court do not have up to date information about the service and the support they can expect. We have made a requirement about this. Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 11 Before anyone moves into Bishop’s Court, staff from the home visit them to complete an assessment of their needs and choices. We looked at an assessment form that had been completed by a member of staff for one person who moved in recently. Information had been recorded about the person’s health needs and a copy of an assessment completed by the hospital had been obtained. However only brief notes on the person’s care needs were recorded. For example, the notes showed that the person requires support with ‘all aspects’ of personal care. However it does not state how this support should be provided or what, if any, equipment is needed. Parts of the form ask for information about the person’s choices and preferences and these sections had not been filled in. There was therefore limited information available about their important relationships, past history and things they do and do not like. Some of the people who live at Bishop’s Court may not always be able to state their choices. It is therefore important that, before accepting a person to live in this home, staff ensure they have recorded as much information as possible about the things that are important to each person. This information would help everyone to decide if Bishop’s Court is the right place to live and if the service can meet their choices as well as their support needs. Intermediate care is not provided at Bishop’s Court so standard 6 does not apply. Bishop`s Court DS0000059340.V367678.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 People who use this service experience poor outcomes in this area. We have made this judgement using available evidence including a visit to this service. Work to improve care plans is continuing and when completed should give staff clear guidance so they know how to meet people’s needs. However, there are shortfalls in medication management so people are at risk of not having their medicines as prescribed. EVIDENCE: Individual care files are in place for all of the people living at Bishop’s Court and we looked at a sample of care plans in detail. Staff told us they are in the process of changing the format of all care files to ensure all the information needed is easy to find. They said that about fifty percent of files have been changed to the new format. Those seen were written in a way which respected each person’s dignity through use of appropriate terms in describing their support needs. This had not been the case at our last visit. Staff appear to be making efforts to make sure each person is referred to with respect in report writing when updating care files. We have made a requirement to make sure
Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 13 that the work on changing the care plans is completed so they are easy to follow and a consistent approach to supporting people will be maintained. We looked at care plans and records in depth for four people. These showed us that people are supported to obtain advice from health professionals such as the GP and optician, when needed. We also spoke with a visiting health professional who said staff consult appropriately when advice is needed. Care records we looked at contained a number of assessments that identified the support people need with their personal and health care and some guidance for staff to follow in providing this. We looked at a care plan for a person living in Bishop’s Court who has diabetes for which they have insulin injections. There was no clear plan in place on how to manage this person’s diabetes. However a record of the acceptable levels for this person’s blood sugars was kept elsewhere and staff were able to explain this. Storing information about individual people in different places may lead to unfamiliar staff not being able to find it quickly to ensure they can give the correct support to people. Also, there was no record of injection sites for this person. It would be good practice to record this information so that staff can ensure the injection is not given into the same site each time, which could lead to health problems. One of the people living in the home told us that she has her hair set weekly by a visiting hairdresser. However she said she had not had a bath for three weeks. On asking, a member of staff agreed to support her to bathe later in the day. There is no system in place for checking how regularly people are taking a bath. As some of the people living at Bishop’s Court may not be able to communicate their choices in this, a system should be in place for ensuring people are offered the opportunity to have a bath when they like. We spoke to the relative of a person living in Bishop’s Court. She said everything is going well and she has no complaints about standards of care. She said her relative appears to be settled and well nourished. One person told us that they complained to staff because they needed a painkiller. Staff had told them this could not be given without GP permission; they had spoken to the GP and the person’s painkillers were due to arrive in two to three days. Administration of medicines to residents was observed. This was done with care and records were completed at the time of administration to each person. However, some people had their medicines quite late in the morning. This means that where medicines are repeated later in the day, the time between doses may be too short. Residents’ health could be at risk if medicines are given at times that are too close together. The times that medicines are given Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 14 needs to be looked at to ensure they are given at the right and best times for people at the home. We compared medicines records and stocks and found discrepancies that put people at risk of medication errors. We saw two examples where records for ‘short courses’ of treatment showed that more doses of medication had been given than were actually received into the home. We saw other examples where records showed medicines had been given correctly, when the quantity remaining in stock suggested they had not. Not giving medication as prescribed may effect people’s health and wellbeing. We found that one person had not been given one of their night-time medicines for eleven nights because there was none left to give (run out). Recent records showed that the resident was having disturbed nights, ‘shouting out at times’, ‘unable to sleep’ and ‘shouting until midnight’. The missing tablet has a sedative effect and missing doses may have contributed to the disturbed nights. An order for more tablets was placed on the day of our visit. Records of communications with, and advice from, health care professionals such as doctors were not always clearly made, so it was not always clear when medicines had been changed or ‘started’. There was a lack of information about the correct use of medicines prescribed to be taken ‘when required’. To help ensure consistency, there should be individual guidance about when these medicines should be given. Managers explained that this would be addressed as new style care plans were completed. Similarly, one person complained of pain and was asking for painkillers. Nurses initially said that a prescription had been ordered from the doctor, but then explained that one may not be available because there was a risk the person may take painkillers ‘habitually’. Nurses spoken with agreed that there should be more information about pain management and requests for pain relief in the individual’s care plan, to help ensure pain is well managed. Medicines, including controlled drugs, were safely stored but there were several unwanted ampoules that needed to be sent for safe disposal. Nursing staff explained that they were not sure how to safely dispose of these medicines and they were recommended to seek advice promptly from the waste contractor for the home. There were two administrative errors in the Controlled Drugs Register. To reduce the risk of mishandling, it is important that this register is accurately completed and reflects actual stock held in the home. Qualified nurses giving medicines to residents have been given copies of current guidance on the safe handling of medication but the home does not have a comprehensive policy describing the handling of medication at Bishop’s
Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 15 Court. It is important that a policy is available to provide written guidance for staff on safe handling of medicines in the home. Written audits (checks) of medication are carried out and managers said a more comprehensive audit was planned. It is important that regular audits are carried out to help ensure medicines are safely handled and any areas for improvement are identified and addressed. Staff were seen asking people living in the home what they would like to eat or drink and supporting them respectfully most of the time. Skills in this vary amongst staff and they have been given a handbook to guide them in care giving, which includes information about people’s right to be treated as equals. Staff told us that people living in the home now have enough of their own clothing and continence aids to avoid the need to borrow these from others. Two relatives of residents told us that people’s clothing had gone missing in the past but things have improved recently. Bishop`s Court DS0000059340.V367678.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 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Action has been taken to meet people’s diverse social and cultural needs. However, some staff support people in a way which shows lack of awareness of each person’s right to equality and respect. EVIDENCE: A full time activity coordinator is employed at Bishop’s Court and we spoke with him about arrangements for social support. A senior manager advised that they are in the process of putting together files for the people living in Bishop’s Court on their lifestyle choices. Once these are complete, staff can plan how they can support people with the things they enjoy. We saw evidence that for some people, this has begun to happen. For example one person is helped to go to a local luncheon club with people of the same religion. Two people have been to a religious service in a nearby care home. A person who lives in Bishop’s Court, who described the activity coordinator as, “Clever, good hearted,” and explained she has support to go
Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 17 food and clothes shopping which she enjoys and is hoping to go to a music event at a local club shortly. A member of staff told us that one person living in the home enjoys reading the papers and a daily newspaper is provided for them regularly. There is evidence that a lot of work has been done to improve activities for some people living in Bishop’s Court and their quality of life has improved because they are going out regularly. This is not the case for some of those people who are physically frail and not able to express an opinion on what they would like to do. During the late afternoon and evening of our visit, residents were seated in both lounges with no music, a lack of stimulating activity, and little engagement with staff other than to those related to tasks. A member of staff was asked if there were ever activities during the evening in Bishop’s Court and she said she had not seen any. A visitor to Bishop’s Court said that she always feels welcome when she calls in and that staff are pleasant and helpful. The general manager said that there are plans for people’s families to become involved in the residents’ committee to represent them and have a say in the running of the home. One of the people we spoke with told us, “I get what I like to eat,” and knew what was for supper that evening. Another person said that the food was, “All right, but that roast dinners do not have either roast potatoes or Yorkshire puddings”, and asked, “How is that a roast dinner?” The views of people who live at the home about their food likes and dislikes and improvements they would like to see should be sought. A copy of the four weekly menu is kept in the dining room, so that people can read it every day. The menu of the day was written up on a notice board in the dining room, with the day and date, which is helpful to people who have difficulty remembering. The nurse on duty in the dining room told us that the menu had just been reviewed to provide more seasonal choices for people. She said meals are prepared to meet the special dietary needs set out in the care plans, for example diabetic, soft diets and supplements. The general manager told us that “finger foods” are to be introduced into the menu and placed on a table in the dining room for the people who may not want to sit down to a meal, and would benefit from having food they can pick up and eat as they walk around. The dining room was in good condition with clean tablecloths and some new furniture. A designated member of staff has responsibility for the condition of the dining room and service area and appears to have made a number of environmental improvements. Arrangements for mealtimes have been changed and there were two meal sittings. The small dining room is now used as a crafts room as all people eat in the main dining room at different times. Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 18 We observed the first sitting. There were nine people using the dining room with five members of staff who were giving full help to people who need it, with their food. If people were not eating the meal they had been served, they were offered an alternative. One person was not taking her food; a care assistant informed the nurse about this. The person was offered a drink and yogurt and given assistance by a member of staff. During our observations in the dining room, two members of staff were helping people to their chairs, by using wheelchairs and a portable hoist. As people sat down at their tables, they were offered a hot or cold drink, they were asked what they would like to eat and were served without delay. There was a choice of chicken pie, vegetables and new potatoes or quiche and ham salad with strawberry cheesecake and ice cream to follow. One person asked for a sandwich. Another person likes to discuss his meal with staff and is precise about the portions to be served. The atmosphere was calm and much improved from our last visit. Because staff had time to help them, people appeared more relaxed when eating. A person we had seen calling out throughout mealtimes on two previous visits had been served without delay, and was enjoying the meal. A member of staff was seated at the table with this person, responding to him and chatting. We also observed the second sitting of the evening meal. Two people sitting together had their meal of quiche, green beans and new potatoes in front of them. Both meals had been served on plastic plates and neither person had been given cutlery. One person tried to eat her beans with her fingers then tried to pick the plate up, at which point some of the potatoes rolled off. She replaced the plate and did not try to eat her meal again. After a couple of minutes a member of staff came and sat with this person, got a fork and gave her some food. The member of staff then walked around the table, picked a potato off the second person’s plate and with her fingers put it into the person’s mouth. She then walked back to the first person and gave her a fork full of food. The staff member then got a second fork and went to the second person; holding a potato with her hand, she cut it with the fork and used this to give her some food. The member of staff did not talk to either person or try to explain what was happening. Helping two people to eat at the same time, using fingers to give food and not making sure sufficient cutlery is available at the start of a meal shows a lack of respect and understanding of people’s right to be treated with dignity. We have made a requirement for the home to deal with this. Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 19 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 People who use this service experience poor outcomes in this area. We have made this judgement using available evidence including a visit to this service. Remedial action has been taken where complaints have been upheld but not all staff have received training on safeguarding adults so people living in the home could be at risk of abuse and poor practice. EVIDENCE: There is a complaints procedure for Bishop’s Court and a record of complaints made is held in the home. We looked at the record of a complaint from a resident’s family about loss of jewellery belonging to a person who lives at the home that the manager had investigated. The outcome of the investigation was that no explanation for the loss could be found. The manager told us that the person would be compensated. Two allegations of theft of money have been made recently in Bishop’s Court. The general manager had referred these to the police. We have received one complaint at CSCI about Bishop’s Court in the past twelve months. We looked at this at our last inspection and made requirements. Action has been taken to meet the requirements: there is to be a separate laundry for Bishop’s Court and work on this is progressing; the boiler thermostat has been repaired; sufficient continence aids are now provided; and training was given to make sure that medicines were given safely and appropriately to people who live in the home.
Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 20 Although there are procedures in place for their guidance, not all of the staff working at Bishop’s Court have received training in identifying possible abuse and reporting it under safeguarding adults procedures. We have repeated the requirement on this that we made at our last inspection. We were advised that some staff have had recent training on safeguarding adults and that more training is planned. However, a lack of clear training records and training plan means that some staff may not have the skills and knowledge needed to identity and report any protection concerns that arise. This could place the safety of the people living in Bishop’s Court at risk of not being protected from poor practice and abuse. There was evidence during the visit, that staff have failed to protect people through omissions in obtaining sufficient supplies of medication and not giving medication to people as prescribed or when needed. A person who complained to staff of being in pain was not given medication to control the pain and another person had not had their night medication for eleven nights because medication had ‘run out’ and it has not been re-ordered until the day of our visit. We checked to see if the statutory requirement notice we issued to the home on 23 May 2008 about physical restraint had been complied with. During this visit, we found no evidence that people living in the home had been physically restrained. The general manager of the home confirmed that staff who need it have received supervision and instruction to improve their skills and knowledge of each person’s right to freedom of movement within the home. Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 21 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 and 26 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Bishop’s Court is comfortable and hygienic so it makes a suitable home for people who live there. EVIDENCE: The building has just been decorated with new furnishings and curtains provided in communal areas. The courtyard garden now has fencing fitted around the flowerbeds and fountain, making this safer for people. There is a fenced off area for pets (rabbit and guinea pig). A member of staff cares for the pets, and it is hoped that people will take an interest in the animals and enjoy handling them. Staff told us that people are using the garden with staff present, until railings are placed around the fencing to support those who are physically frail. The garden now makes a secure outside place for people to enjoy. Being able to
Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 22 go outside in safety will enhance people’s quality of life. There is a secluded area of the courtyard, where one person likes to sit. Staff said that new garden furniture and more parasols will be bought to make the garden more pleasant and comfortable for people. People’s bedrooms that we visited have been personalised and in were good decorative order. Some rooms have en-suites. There is a large shower room that is suitable for people who are physically frail. A bathroom that had been de-commissioned is now to be returned to its original purpose and is to be fitted with a new bath, which the handyperson said is on order. Currently, one bathroom is used as a wheelchair store when not in use, one is used as a cleaning store and one bathroom remains out of use until the new bath is fitted. We have made a recommendation, repeated from our last inspection, that bathrooms should remain in use so there will be plenty of bathing facilities for people to choose from. There are toilets throughout the home and these were clean and well lit at the time of our visit. There is a range of aids in the home, such as hoists, grab rails, raised toilets and assisted baths, to help people who have problems with their mobility. We noted a number of orientation aids, such as signs on toilet doors and bedroom doors, a menu and date chart, when we were walking around the home. These aids help people who may have difficulty remembering things to find their way around without much help and promotes their independence. Staff said they are doing some research on the best signs and pictures to use to help people who have dementia become more familiar with their surrounding. Domestic staff are employed on each shift. It was not possible to check whether training in infection control is up to date as training records were not available during this visit. A member of domestic staff was spoken with and he said there is plenty of cleaning materials and protective clothing for staff. For residents’ safety, cleaning materials are locked away when not in use. The home was clean and tidy throughout and spillages were cleaned as they occurred. Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 23 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 People who use this service experience poor outcomes in this area. We have made this judgement using available evidence including a visit to this service. The vetting of new staff has not been thorough, which places people living in Bishops Court at risk of unsuitable staff being employed to support them. EVIDENCE: At our last inspection of the home in April 2008 we identified that staff files did not contain sufficient information to prove the company had carried out the required checks to make sure that staff are suitable to work with people who may be vulnerable. We served a statutory requirement notice on Bishop’s Court requiring them to provide relevant information on staff files. This included ensuring staff do not start work in the home without a Criminal Records Bureau (CRB) disclosure being applied for and a Protection of Vulnerable Adults (POVA) register check being obtained. The company also needs to check that nurses are registered with the Nursing and Midwifery Council to practice and ensure they have obtained two written references for all staff who have contact with the people living there. We checked files relating to six members of staff. We found that checks have been carried out on nurses’ current registration to practice. Only one reference each had been obtained for four members of staff; the regulations
Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 24 make it clear that two are required. Of the references obtained, some did not contain sufficient information, such as the length of time the person worked in their previous employment, to provide a full history of their employment record. No evidence of a CRB or POVA check was on file for one member of staff. We were advised that a part time worker has started working in Bishop’s Court. Although not directly supporting the people living there, this member of staff will have contact with them. No POVA or CRB check had been applied for regarding this person. There were no records of identification in files for three members of staff. This lack of rigorous recruitment processes may lead to the people living at Bishop’s Court being supported by staff who are unsuitable to work with them and could place people at risk. There was little evidence available of staff training. A senior manager explained that training has taken place on safeguarding adults and moving and handling with more planned. There was no list available to shows which members of staff had undertaken this training. A list on the wall showed seventeen training courses in different aspects of care available in May 2008. Again there was no evidence available that staff had undertaken these training courses. We looked at training analyses completed recently by three members of staff. These showed that none of these staff had attended moving and handling training, only one had received training on safeguarding adults and one had received instruction in fire safety. During our visit, two members of staff said they had not received training on safeguarding adults and one said she has not had any training in dementia care. Four staff spoken with had not received training about using bedrails safely and had little knowledge of the risks these can pose if faulty or not fitted correctly. . If staff are not having regular, up to date training in basic areas of care and safety, they may not be aware of safe methods of supporting people and may place themselves and those they support at risk. We have made a requirement about staff receiving up to date training. Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 25 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 and 38 People who use this service experience poor outcomes in this area. We have made this judgement using available evidence including a visit to this service. Bishop’s Court has lacked consistent management for over a year, resulting in people living at the home being placed at risk and receiving poor quality outcomes. EVIDENCE: Bishops Court has lacked consistent management over the past eighteen months and this has had a negative effect on service delivery and staff morale. To address this situation, since April 2008 Tommy Smith, who is the general manager, has had responsibility for overseeing Bishop’s Court. Judith Keane has recently been appointed as manager of Bishops Court. She is qualified and experienced in managing health care services and has started to make some changes in the way the home is run. She has not yet applied for registration
Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 26 with the commission and the general manager will be supporting her in the post for three months. Staff said that the new manager is approachable and felt that Bishops Court has become a more pleasant place to work recently. Although people’s families are being encouraged to have a say in the management of Bishop’s Court, there was no evidence of a regular internal quality monitoring system for the home, based on seeking people’s opinions. It is recommended that a quality monitoring system be established, so that the service can be developed taking into account the opinions and preferences of the people who live there. We looked at management and security of people’s personal allowances and checked individual records for three people. These had been well maintained with receipts kept for any purchases made on each person’s behalf. The accounts balanced with the amounts of money, which were held in the person’s name, securely in the safe. The manager has changed the way accident records are maintained by making sure there is only one accident book in use at a time. In this way, accident records can be easily monitored and risk assessed with the aim of reducing accidents to residents and staff, by addressing the risk factors identified. Staff and qualified engineers carry out a series of safety checks on the environment and equipment as appropriate to make sure the building is safe for people to live in. The safety certificates and records of these checks were seen, and were up to date. During our last key inspection of Bishop’s Court in April 2008 we found that some of the people living there had bed rails fitted to their beds. Some of the bedrails had large gaps that could lead to the person becoming trapped between the rail and mattress. The company responded by putting extra staff on duty that night to regularly check on the safety of people who have bedrails. We were since advised that the company had replaced beds and rails with equipment that meets current legislation. During our visit on 1 July 2008 we again examined bed rails in use in Bishop’s Court. Whilst some were satisfactory, others were not. Four beds that we looked at were found to have gaps between the mattresses and rails that could lead to someone getting trapped and injuring themselves. The company again responded by putting additional staff on overnight. We made an immediate requirement that bed rails must be risk assessed and action taken to ensure they were safe. We returned to Bishops Court on 3 July 2008 to check if the immediate requirement we made on 1 July 2008 had been met. The company again had extra staff on duty. We were told that they had ordered new bumpers for the rails that they thought would solve the problem of gaps occurring between the
Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 27 beds and the rails. However no written risk assessment of the bed rails had been carried out and no record of regular maintenance checks of the rails was available. We spoke with four members of staff, none of whom had received training from the company on the safe use of bed rails or the risks that can be associated with them. Staff knowledge in these areas varied with some staff telling us they are advised by nurses to place people as far away from the rail as possible. None of the staff appeared to be aware that regular checks need to be made to ensure no gaps are present that could pose a risk. It is a matter of serious concern that the company failed to carry out regular checks on equipment they provide, when a clear risk to people had been previously identified. This could lead to the person using the bed and rail to trap themselves and suffer a serious injury. Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 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 2 17 X 18 1 3 X X X X X X 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 3 X X 1 Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 5 Timescale for action An up to date Service User Guide 01/08/08 must be written, which is specific to Bishops Court, and given to people before they move in. This is to make sure that they have all the information they need to decide if their needs can be met at the home. 01/08/08 Assessments of people’s needs, carried out by staff of Bishop’s Court before people move into the home must cover the complete range of each person’s health, personal care and leisure needs and should be regularly reviewed while they are living in the home to make sure that their care needs are being met in the most appropriate way. Work on changing care plans to the new format must be completed so that support plans for health care and personal care are easy for staff to access and follow. In this way a consistent approach to supporting people will be maintained.
DS0000059340.V367678.R01.S.doc Requirement 2 OP3 14 3 OP7 15 29/08/08 Bishop`s Court Version 5.2 Page 30 4 OP9 13(2) Medication must be administered as prescribed, and clear and accurate records of medication administration must be maintained to make sure that people’s health and wellbeing is protected. 01/08/08 5 OP9 13(2) A written policy on handling 29/08/08 medication must be implemented to ensure consistency in the handling of medication and to help ensure residents are protected by the home’s arrangements for handling medication. Sufficient stocks of medicines 01/08/08 used by people who live in the home must be maintained to make sure these do not ‘run out’ so people receive their medicines as prescribed. The Controlled Drugs Register 01/08/08 must be kept accurately to make sure that it reflects the actual stocks being held and to reduce the risk of mishandling controlled drugs. Consultation with residents 29/08/08 and/or their representatives must take place to find out their views and preferences about daily recreational activities inside and outside the homes. This is to ensure residents receive social support that meets their individual needs. (This requirement was made at the two previous inspections with timescale for compliance of 17.01.08 and 30.06.08. It remains unmet.) Staff who help residents at
DS0000059340.V367678.R01.S.doc 6 OP9 13(2) 7 OP9 13(2) 8 OP12 16(2)(m) & (n) 9 OP15 12(4)(a) 29/08/08
Version 5.2 Page 31 Bishop`s Court mealtimes must receive guidance on how to provide suitable support. There must be enough staff on duty at mealtimes to support each person individually and (subject to risk assessment) a supply of cutlery and condiments must be available for each table. This is to ensure that people living in the home are treated with dignity and respect during mealtimes. 10 OP18 13 Staff must receive training on safeguarding adults to make sure they are aware of the indicators of abuse and the actions to be taken to report suspected abuse. This is to make sure that residents are protected from harm and abuse. (This requirement was made at the last inspection with a timescale for compliance of 30.06.08. It remains unmet.) Bedrails must be checked regularly to make sure they meet safety guidelines and do not pose a risk to those people who are using them. Risk assessments must be carried out to make sure that it is appropriate and safe to use bedrails for each person. (This requirement was made at the last inspection with a timescale for compliance of 30.06.08. It remains unmet.) 29/08/08 11 OP38 13(6) 01/07/08 12 OP29 19(4)(b) & Schedule 2 Thorough recruitment checks 01/07/08 must be carried out for all staff, to include two references being obtained, a CRB disclosure being applied for and a POVA first check being obtained before staff start working in the home. This
DS0000059340.V367678.R01.S.doc Version 5.2 Page 32 Bishop`s Court is to make sure they are suitable to work with the people who live in the home and to protect residents from possible harm and poor practice. (This requirement was made at the last inspection with a timescale for compliance of 30.06.08. It remains unmet.) 13 OP30 18(1)(c) Staff training needs must be 29/08/08 reviewed. A training plan to show when staff will receive all the up to date training they need to make sure they have the skills needed to support the residents at Bishop’s Court must be drawn up and implemented. (A requirement was made at the last inspection that staff must receive up to date training, with a timescale for compliance of 30.06.08. It remains unmet.) Staff must receive training about caring for people with dementia so they can provide good quality care for the people living in the home who have dementia. (This requirement was made at the last inspection with a timescale for compliance of 30.06.08. It remains unmet.) 30/09/08 14 OP30 18(1)(c) 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 OP9 Good Practice Recommendations The times that medicines are administered should be
DS0000059340.V367678.R01.S.doc Version 5.2 Page 33 Bishop`s Court monitored and where needed, action taken to ensure medicines are given at the right and best times for people at the home. Requests for painkillers should be responded to appropriately, taking prompt advice from GPs where necessary, to ensure that people’s pain is managed effectively. Regular checks of controlled drugs handling should be carried out to ensure records are accurately completed and to reduce the risk of mishandling. 2 OP7 The social, emotional and cultural needs of people who live at the home should be reviewed and detailed relevant support plans be written to make sure that staff have guidance as to how these needs should be met. Staff should receive guidance on promoting the principles of dignity, rights and choice when providing support for residents to make sure that the people who live in the home are treated with respect in all aspects of their life in Bishop’s Court. The people who live in the home (or their family) should be consulted about their food preferences to make sure that people have the meals they like. To ensure that residents have sufficient bathing facilities it is recommendation that bathrooms are not subject to ‘change of use’. A quality monitoring system should be developed based on the opinions of residents and their representatives so that the service will be developed in accordance with people’s opinions and preferences. The manager should apply for registration with the Commission for Social Care Inspection, as required by the Care Standards Act 2000. Staff should receive training in use and safety of bedrails to ensure they are competent in their use and in identifying any related hazards, so that people in the home are protected from the risks posed by poorly fitting bedrails. 3 OP10 4 OP15 5 OP19 6 OP33 7 OP31 8 OP38 Bishop`s Court DS0000059340.V367678.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection North West Region CSCI Preston Unit 1 Tustin Court Port Way Preston PR2 2YQ 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
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