Inspection on 13/01/09 for Bishop`s Court

This inspection was carried out on 13th January 2009.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bishop`s Court 13/07/09

Bishop`s Court 17/10/08

Bishop`s Court 01/07/08

Bishop`s Court 14/04/08

Bishop`s Court 08/06/07

Bishop`s Court 29/06/06

Bishop`s Court 12/01/06

Bishop`s Court 17/11/05

Bishop`s Court 27/07/04

Bishop`s Court 10/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

CARE HOMES FOR OLDER PEOPLE Bishop`s Court Sefton Park Care Village Sefton Park Road Liverpool Merseyside L8 3SL Lead Inspector Trish Thomas Unannounced Inspection 13 January 2009 10:00a 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.V373614.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.V373614.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.V373614.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 17 October 2008 3 Date of last inspection Brief Description of the Service: Bishop’s Court is a care home in a busy suburb of Liverpool and is registered for forty-one people who have dementia. 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 en-suite facilities. The home is close to Liverpool city centre, to local shops and public amenities. It is owned by European Wellcare Homes Limited, and a new manager has recently been appointed. The fees per week in Bishop’s Court range from £440.00 to £550.00 and there are extra charges for chiropody and hairdressing. Bishop`s Court DS0000059340.V373614.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 1 star. This means the people who use this service experience adequate quality outcomes. We made an unannounced visit to Bishop’s Court on 13 January 2009. Three inspectors, (including one of our pharmacy inspectors) and an ‘Expert by Experience’, took part in the inspection. An Expert by Experience is a person who has experience of using services for older people and has received training in taking part and contributing to the inspection process. Following the visit, the expert prepared a report of their findings and those views are included in this report. We spoke with the manager of the home and the deputy manager who has been appointed since our last visit. We also spoke with staff who were on duty at the time of our visit to find out about their understanding of their roles and responsibilities. We looked at records kept in the home including care plans, safety records and staff recruitment files. This was to check the care that people who live in the home receive and to see whether requirements about these that we made in previous inspections had been met. Medicine systems were checked to make sure that medicines were being safely managed. At previous inspections we had found this was not being done and we made requirements, including serving a legal notice. This was to make sure that improvements were made and that people living at Bishop’s Court were receiving their medicines safely, as prescribed by their doctors. We looked at care plans of five people who in Bishop’s Court in detail and then tracked the care they were getting to make sure they were receiving support which meets their needs safely. We also checked that the care records were up to date and gave clear guidance for staff about what they had to do to meet people’s needs. We spoke with people living in Bishop’s Court to find out about their experiences there, and spent time with them in the lounges. The expert focused on how people living at the home experienced mealtimes through observing the midday meal in the dining room. What the service does well: The building has been refurbished so it provides a bright, comfortable home for people with plenty of space for them to move about freely, both inside and out. A visitor who lives in Bishop’s Court told us that the place is much brighter and Bishop`s Court DS0000059340.V373614.R01.S.doc Version 5.2 Page 6 is always clean when she visits. A person who recently moved in prefers to spend time in the bedroom and said, “I have all I need here.” What has improved since the last inspection? What they could do better: There should be a care plan for every person who moves into Bishop’s Court that sets out their needs and preferences about health, personal and personal care. This is to make sure that staff have the information they need to meet every person’s needs in the way that person prefers. The manager should monitor care records to ensure that they are legible at all times. This will help to ensure there is clear information about the people available for the staff so the support they need is readily available. Appropriate arrangements must be made for handling and recording of prescribed external preparations (e.g. creams) to help ensure they are safely used as prescribed. Where several doses of medication are missed, GP advice should be sought and recorded to help ensure people receive the best treatment. Consideration should be given to the times that medicines are given to help ensure they are as far as possible - offered at both the right and best times for people. Discussions should be held with the staff team as to the importance of always talking to and about people in an adult manner and the effects this can have on those they support. This will help to ensure people are treated in an adult, respectful manner at all times. One person’s clothing was in poor condition and should be replaced to respect the person’s dignity. This person’s special needs regarding damaged clothing need to be identified in their care plan so that staff are aware of how to deal with this aspect of the person’s care. Bishop`s Court DS0000059340.V373614.R01.S.doc Version 5.2 Page 7 The manager should arrange for guidance to be given to staff about respecting people in the way their social histories are written to make sure that these are written appropriately. The staff should consult with the people living in Bishop’s about the meals provided and alter menus based on their choices. This will enable people to have more direct control over their everyday lives, including about what they eat. More attention needs to be given to the way people are supported with meals because, due to the way meal times are managed, there is a lack of consistency in the way people are given help with their food. Care plans for people’s cultural and religious needs should be updated regularly as new information is obtained. This will help to make sure, that as far as possible, staff are supporting people with their chosen diet and lifestyles. Careful consideration should be given as to whether it is appropriate to provide Halal meat for everyone living at Bishop’s Court, as is currently the case. The personal, cultural and religious needs of everyone who lives in this home should be accounted for when purchasing meat supplies. Staff should also ensure that this information is freely available to people who are considering moving into Bishop’s Court. All staff should receive training (updates) in safeguarding adults to ensure they have the skills to protect people where abuse may be suspected. The bath chair, which has been in need of repair for over three months, should be repaired to ensure there is enough equipment to move people safely and comfortably when bathing. An action plan with clear dates should be drawn up to ensure all information required about staff is available within the home. This will help to ensure that the findings of the recent staff file audit are fully implemented. It will also help to ensure all staff are suitable to work with the people living at Bishop’s Court. A staff training needs analysis should be carried out, to make sure that training is available to ensure that the different needs of people living at Bishop’s Court can be met appropriately. A training plan should be developed from this and clear records should be kept of all the training staff undertake. This will help to ensure staff receive appropriate training to support the people living at Bishop’s Court safely and well. The manager of Bishop’s Court should apply for registration with the Commission for Social Care Inspection, as required by the Care Standards Act 2000. Bishop`s Court DS0000059340.V373614.R01.S.doc Version 5.2 Page 8 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.V373614.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.V373614.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 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. Information about people’s support needs is not always available when they move in to Bishop’s Court, because some assessments are incomplete and have not been written clearly. This means that people’s needs may not be met appropriately when they move into the home. EVIDENCE: One person who lives at Bishop’s Court who we spoke with told us, “I like it here. They are good to me”. We looked at care records for some of the people who have moved into Bishop’s Court recently. These showed that before anyone moves into the home staff from the home carry out an assessment of their needs. Bishop`s Court DS0000059340.V373614.R01.S.doc Version 5.2 Page 11 One of the assessments we looked at had been comprehensively completed and provided a good basis for staff to plan how they would support the person. A second assessment had not been as fully completed, with information missing about the person’s sight, hearing and oral health. Assessments are completed by hand and we noted that the handwriting on this second assessment was very hard to read. This along with incomplete sections could lead to the person not getting all of the support and care that they need. One person whose file we looked at had moved in to Bishop’s Court under emergency admission procedures from hospital. A social worker’s assessment had been provided to staff when the person moved in and this gave plenty of information on which to base a care plan. The service user guide for the home is given to people to provide them with information about the home before they move in. This has recently been reviewed to make sure that the recent changes in the line management for the home within the organisation that owns and runs it are identified in the document. Bishop`s Court DS0000059340.V373614.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 adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Care plans for people living at Bishop’s Court have been transferred to a new format that is person centred and easier to follow, so that it is clear what people’s needs are and how they should be met in the way that people prefer. However these did not always have enough information about people’s health care so they may not receive the checks they need to stay healthy. EVIDENCE: The people living at Bishop’s Court told us that they get help with their health and personal care. One person told us, “If I need any help they help me. They watch my leg”. Individual care files are in place for most of the people who live at Bishop’s Court and we looked at a sample of these to see what care needs people had and how these were being met. Letters on file showed that staff are beginning the process of asking relatives to review and discuss the person’s care file. Bishop`s Court DS0000059340.V373614.R01.S.doc Version 5.2 Page 13 This will help to support the people living at Bishop’s Court who may not be able to make their needs clearly known so their choices and preferences can be made clear. We found that records about skin breaks or pressure sores were clearly recorded along with the action staff should take to monitor and improve the person’s condition. We also found clear short-term care plans had been put into place to support people with an acute health issues. For example, one person had developed a chest infection and clear guidance was recorded on how staff should support them with recovering from this. Health and risk assessments were on file for people for areas such as moving and handling, pressure areas, nutrition and continence. These assessments provide a good way for staff to assess the level of support the person’s needs in a particular area. However, there were gaps in one of the assessments we looked at where the person’s nutrition assessment had not been completed. We found parts of this person’s care plan difficult to read due to the handwriting used. A comprehensive risk tool document was seen in people’s files. This uses a series of scores to assess any risks to the person. We found the completion of these varied. One plan contained a fully completed risk tool that included the actions staff should take to minimise any identified risk. However another had been completed with the scores but did not contain guidance on how to minimise the identified risks. We also saw a well-completed health assessment document for one person that clearly identified their health needs. Although this stated that they needed a medication review and re-assessment by the continence team, we could not find records in their plan that these things had been arranged and carried out. Similarly a record of health professional visits showed that the person had seen the optician recently. However no recording of visits by the chiropodist or dentist for example were completed. In order to ensure people are receiving basic healthcare checks it is important that information is recorded about when these were last carried out and are due again, so that people can be supported to stay as healthy as possible. One person who had been living in Bishop’s Court for over two weeks did not have a care plan. Staff appeared to be using daily care notes for guidance in supporting the person and this could place the person at risk of not receiving proper support. An immediate requirement was given that a care plan be written for this person to ensure staff have the guidance they need to support the person properly and safely. In one person’s care file we saw comments in their social history that were inappropriate and not relevant to the person’s current care needs. It is recommended that this information be held securely elsewhere and staff be Bishop`s Court DS0000059340.V373614.R01.S.doc Version 5.2 Page 14 given guidance as to how to support people’s dignity and confidentiality in compiling care records. Most of the people we met who live in Bishop’s Court looked well groomed and there have been no further complaints about clothing going missing. One person’s clothing was in poor condition and should be replaced to protect the person’s dignity. This person’s special needs regarding damaged clothing needs to be addressed in the individual’s care plan and clothing should be replaced as necessary. We observed that staff spoke respectfully to people when supporting them. However they do not always explain their actions to people. We saw one person being helped to move from a wheelchair to an armchair, using a hoist. Staff did not explain to this person what they were doing, which could lead to people becoming confused about what was happening. We also overheard some staff talking about people who were in the room. These were not negative comments and included phrases such as, “Isn’t she lovely”. Talking about people as though they are not present does not support the principles of building equal relationships based on respect for each other as adults. As part of the inspection a pharmacist inspector looked at how medicines were handled. We looked at medicines administration. Consideration had been given to the timing of the medication rounds. Nurses said that most people had usually had their breakfast medicines by 10:30, although it was later than this on the day of our visit. Further monitoring of the medication rounds should be carried out with consideration given to offering greater flexibility for example, depending on whether people are early or late risers. We saw some records that showed people had refused several doses of medication at certain times of the day. Where people miss several doses of medication, GP advice should be sought to help ensure they receive the best treatment. We checked medicines record keeping. Records for the receipt of medicines into the home, and safe disposal of unwanted medicines were generally clearly recorded. Medication administration records were generally well maintained clearly showing the treatment people had received, but those for prescribed creams were sometimes less well completed. We also saw that one persons care plan had not been updated to detail the use of the creams and external preparations currently prescribed. Further improvement is needed to demonstrate that external preparations (e.g. creams) are used as prescribed. Records for communication with healthcare professionals such as doctors were generally clearly made, so changes to people’s medicines could mostly be tracked. We found information about the use of when required medicines was not always recorded. Information about the individual use of these medicines and how the need may be made known is useful in helping to ensure consistency in their use. Bishop`s Court DS0000059340.V373614.R01.S.doc Version 5.2 Page 15 We looked at how medicines were stored and found that all medicines including controlled drugs were safely stored, helping to reduce the risk of mishandling. On the whole adequate stocks of medicines are kept at the home without overstocking. But we saw one example where someone had missed one prescribed medicine for almost a week as none had come with the monthly delivery. Although action was taken by the home, this could have been done more quickly. The manager explained that procedures were being introduced to help ensure missing prescriptions would be picked up and addressed before the medicine was needed. The home’s policies and procedures provide written guidance for staff about safely handling medicines in the home. Regular audits are carried out to help ensure that should any weaknesses be identified they will be promptly addressed. Bishop`s Court DS0000059340.V373614.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. There has been some progress in making a wider range of activities and outings available for people who live in Bishop’s Court. However more work is needed to understand and address people’s cultural needs and beliefs to make sure that activities on offer are suitable for their needs. EVIDENCE: The manager told us that religious ministers visit residents of Bishop’s Court, and there is a church service on site. Also the hairdresser visits; lunch and shopping trips continue and there is a full time activities co-ordinator working at the home. There is a three-week activity planner and individual activities plans are in place. This is part of the ongoing work to improve the lifestyles of people who live in Bishop’s Court. One of the people living at Bishop’s Court told us that they are able to have visitors whenever they want. We observed that people can see their visitors in the lounges or in private in their bedrooms as they prefer. Staff support the people living at Bishop’s Court to stay in touch with with their family and Bishop`s Court DS0000059340.V373614.R01.S.doc Version 5.2 Page 17 friends. For example, we observed a member of staff accompanying one person in a taxi so they could go and visit their family. One person living there told us that staff help her to go to the local shops and hairdressers. This support helps people to become more involved in their local community and to stay active, with the opportunity to join in social occasions. During the afternoon we observed staff sitting with the people living at Bishop’s Court, chatting, singing and reading the paper with them. One person told us that she enjoyed watching an entertainer who recently came to the home, although at other times she feels there is, “nothing” to do in an afternoon and would like more arranged activities such as bingo. Photographs in the hallway showed that some of the people living there had enjoyed a summer holiday, arranged by the home, to Blackpool. People told us that they can have a drink whenever they want one. We saw one person ask for and receive a cup of coffee from a member of staff and commenting it was made, “just as I like it”. People living in the home who we spoke with described meals in the home as, “All right” and, “Okay”. One person explained they “Need variation” and would like different alternatives to be provided. Since our last inspection of the home a “lite-bite” menu has been introduced. This is clearly displayed in picture format to make it easier for people to understand. It is available day or night and offers people a choice of a hot or cold snack at any time. One care plan that we saw for a person living at Bishop’s Court identified that they need Halal meat in accordance with their culture. Information on this had been provided in their care file along with a letter from the main kitchen stating that all meat provided is Halal. However in discussions with staff it was unclear as to how often the type of food the person preferred was actually provided. The person’s care plan explained that they communicated sometimes in their first language but staff felt this had changed. However the care plan had not been altered. This lack of up to date information about people’s cultural and religious needs could lead to them not receiving the support they need. We could not find any evidence that the people who live at Bishop’s Court had been informed that the all meat they are provided with is Halal. As there are people of other faiths living in the home, they should be asked if they have any objections to this. There were visitors coming and going during our visit to the home. One person told us her relative is well looked after and there have been a lot of improvements lately such as clothes being returned after laundering, improved staff morale and lots of upgrading throughout the building. Bishop`s Court DS0000059340.V373614.R01.S.doc Version 5.2 Page 18 More attention needs to be given to the way people are supported at mealtimes. Because of the way meal times are managed, there is a lack of consistency in the way people are given support with their food. The expert by experience who came on our visit observed the midday meal and wrote a report on her findings. She has told us that the dining room was light and clean, tables were laid with cloths, cutlery and flowers and there was relaxed music playing. She noted that people were given choices about what they wanted to eat and most were offered a drink when they arrived in the dining room. She saw that some people who needed help with their meal received uninterrupted support in a relaxed atmosphere. Other people had a different experience as some were left waiting for their food because staff were too busy to help them. Another observation was that staff did not appear to notice one person who came in, meaning the person was not attended to. For others their meal was interrupted when staff who had been helping them left to do something else. It was noted that there is a finger food menu for people who may be hungry between meals and details of this were on the notice board in the dining room. The expert noted that staff were recording what people had eaten at the end of the meal and this appeared to be passed on by word of mouth from one member of staff to another. Given the demands on staff during mealtimes, this way of monitoring people’s diet could lead to people missing a meal or not being given an alternative as many are not able to tell staff when they are hungry. The expert by experience observed that the chairs in the dining room were not suitable for more frail people who need more support when seated at the dining table. We visited the main kitchen where there is a full time cooking staff and kitchen assistants employed. The kitchen was clean and the equipment was in working order. The food stocks were high and catering records had been maintained. Given the cultural diversity of people who live in Bishop’s Court, we discussed the diets which need to be provided in accordance with their beliefs and preferences. There was plenty of written information in the kitchen to guide staff about dietary requirements for different cultures. We found that the catering arrangements in place are not meeting the cultural needs of all the people who live in Bishop’s Court. There were no menus in place for people who are Muslim and Jewish and no arrangements for obtaining Kosher or non-Halal meat for people of other faiths. It will therefore be necessary to consult with people (and their representatives) and address their individual cultural dietary needs through assessment and care planning. Many of the people who live in Bishop’s Court are not able to express their needs and may be receiving a diet that is not in accordance with their beliefs and preferences. It is the responsibility of staff to ensure their diverse needs are respected in practice. Bishop`s Court DS0000059340.V373614.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 adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. There are complaints procedures and safeguarding adults procedures to help make sure that people living at Bishop’s Court are protected from harm and their concerns are taken seriously. More safeguarding training is needed for staff to make sure they are know what to do to protect the people who live at the home from abuse and harm. EVIDENCE: There is a complaints procedure for the home and this is given to people with the service user guide and is displayed on the notice board. Staff had taken action by reporting an allegation to Careline (Liverpool Social Services) under safeguarding adults procedures. We were notified of the incident and the matter was being investigated at the time of our visit. We checked whether staff have received training in safeguarding adults, as they all need this training so they know the indicators of abuse and how to go about reporting suspected abuse. The training records show that training in safeguarding is not up to date for some staff and this needs to be addressed to make sure that the people living at Bishop’s Court are protected from harm. Bishop`s Court DS0000059340.V373614.R01.S.doc Version 5.2 Page 20 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, 22 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. The home is maintained so that people living there live in clean, pleasant and comfortable surroundings. EVIDENCE: We walked round the building and grounds to see the facilities available for people who live at Bishop’s Court. We saw that the home was in good condition following a recent refurbishment. There is plenty of space for people to move around and a choice of lounges, including one for people who smoke. There is also a large dining room with enough tables and seating for the people who live in the home, with an adjacent serving area. There is a wellmaintained courtyard garden, which is secure, meaning people are safe when using this space. We saw ten bedrooms and found them to be pleasant, with en-suite facilities or hand wash basins. Some of the bedrooms had photographs of family and friends and personal items to make them interesting Bishop`s Court DS0000059340.V373614.R01.S.doc Version 5.2 Page 21 and homely for people. One person told us he likes his bedroom and has all he needs there. A visitor told us the home is always bright and clean now and the environment has been much improved recently which makes it more a more pleasant home. There are toilets throughout the building and bath and shower rooms are equipped with aids and adaptations such as adapted baths and shower chairs. This enables people with mobility difficulties to get support with their personal care more easily. However we noted that one bathroom had a bath chair that was labelled as out of action. The sticker on this recorded that it had been tested in September and again in December 2008 and was “awaiting repair” on both occasions. This could lead to other bathing facilities being more heavily used and therefore impact on when people can receive support to have a bath. The building is clean and well organised. There were two domestic staff on duty during our visit and they told us there is always plenty of cleaning materials and protective clothing for their use. They said that there is a locked cupboard for securing cleaning materials when not in use, which is in keeping with health and safety procedures. They said they are kept busy following routine cleaning schedules to cover all areas and keep the home clean and odour free. Bishop`s Court DS0000059340.V373614.R01.S.doc Version 5.2 Page 22 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 adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Shortfalls in record keeping make it difficult to track and plan training for staff and ensure that all checks are carried out before people are employed. This could place people living at the home at risk if staff are unsuitable or lack the skills needed to support people safely. EVIDENCE: At our last big inspection of Bishop’s Court in October 2008, we looked at a requirement that we had given that they train all staff on safeguarding adults from abuse. At that inspection we were told that eight staff had received training and saw dates for training in November 2008 for other staff. However at this inspection we were given a training matrix (chart) that showed what staff training had taken place. This showed that only eight staff had received training on safeguarding adults. This training matrix provided by the home lists all staff along with subjects they should receive training in. It states that it is a legal requirement that all staff receive training in induction, first aid, moving and handling, COSHH, health and safety, food safety and the protection of vulnerable adults. Bishop`s Court DS0000059340.V373614.R01.S.doc Version 5.2 Page 23 An audit of the service by the organisation that runs the home was carried out in October 2008 and states that, “mandatory training has been completed with additional training booked”. We noted that a staff file we looked at contained information that that person had had training in manual handling, infection control and dementia awareness as well as induction standards. However this was not recorded on the matrix that we were given. A lack of clear records of if and when staff have received basic training means that the managers cannot monitor whether staff have been provided with up to date information on how to support the people living at Bishop’s Court safely and well. It also means that future training based on the needs of the people living there and current staff knowledge cannot be planned effectively. We met a member of staff from the organisation that runs the home who explained that they have introduced separate training for staff around supporting people with dementia and explain future plans for providing this training at different levels so staff can increase their knowledge. Once fully implemented this training will help to make sure that staff can support the people living at Bishop’s Court with their specialist needs more effectively. We looked at records of four members of staff with different roles within the home, to see how they had been recruited. After previous inspections, we have had taken action with the home because we found they were not carrying out all the necessary checks to make sure staff being recruited were suitable to work with the people living at Bishop’s Court. The managers of the home have recently audited the staff files to identify whether any required information was missing. We saw evidence that they are now taking steps to obtain this. All the files we saw showed that all the necessary checks, including completed application forms, proof of identification, checks of the protection of vulnerable adults register and Criminal Record Bureau disclosures are obtained for all newly recruited staff. However we found that, following our last inspection of the home in October 2008, a member of staff had been appointed for whom only one written reference had been obtained. We also noted, and a member of staff confirmed, that no check had been carried out to confirm whether a nurse working at the home is currently registered with the Nursing and Midwifery Council as fit to practice. In not carrying out these prior to appointing a member of staff, the organisation is not doing everything it can to ensure that staff are suitable to work with people who may be vulnerable. We sat in the lounge for a period of time whilst some of the people living there were in the dining room having their evening meal. A member of staff was in the lounge on her own at times with several people. She spent time chatting and reading with people but was also engaged in supporting a lady who appeared agitated. When she rang for help from other staff this was provided. However the managers should monitor where staff are best placed to support Bishop`s Court DS0000059340.V373614.R01.S.doc Version 5.2 Page 24 the people living there, as it appeared that one member of staff was insufficient to meet all the needs of the people in the lounge at that time. We later observed a couple of members of staff sitting in the lounge laughing and chatting with the people living there. It was clear from people’s reactions that they felt comfortable with the staff and were enjoying the banter and company. Bishop`s Court DS0000059340.V373614.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 adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. People living in Bishop’s Court are protected through the safety checks on the building and the way their money is managed but there needs to be more consultation with them about how their home should be run to make sure it is run in their best interests in the way the prefer. EVIDENCE: Since our last visit to Bishop’s Court a new manager for the home has been appointed and the general manager who had been overseeing the home until a manager was in post has moved on. The manager is a registered general nurse and has a management qualification (NVQ Level 4). A deputy manager is also working in the home. This role is currently supernumerary to nursing Bishop`s Court DS0000059340.V373614.R01.S.doc Version 5.2 Page 26 hours to give the deputy manager time to carry out ongoing work to improve care plans and standards of care management and to ensure staff receive the supervision they need. Because of the number of changes of manager at Bishop’s Court, the home has not had a registered manager for two years and the current manager should apply for registration with the commission, as required by the Care Standards Act. There has been no recent quality survey done for Bishop’s Court and this will be needed to make sure that the opinions of people who live there and their representatives are known and obtained to influence the way the home is run. We saw records and certificates that showed regular checks are carried out on the building and equipment. These included checks of electrical appliances, the gas supply and fire safety equipment. These checks help to ensure that Bishop’s Court is a safe place for people to live and work in. We checked records and amounts of money held for two of the people who live at Bishops Court. We found that records and the amount held tallied and that two staff sign for any transactions. This is good practice as it helps to lessen the risk of errors occurring. We also found that following a requirement at our last inspection the home are now providing statements on people’s care file as to whether they act as appointee for the person’s benefit money and the reasons why. This helps to ensure that the organisation only acts as appointee when there is no alternative available Bishop`s Court DS0000059340.V373614.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Bishop`s Court DS0000059340.V373614.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (1) (2) Requirement There must be a care plan in place for each person living in Bishop’s Court that sets out in detail the action staff need to take to ensure that all aspects of the healthcare, personal care and social needs of the person are met. This requirement was made at the last inspection, with a timescale of 24/11/2009. The requirement has not yet been met in full. 2 OP9 13(2) Appropriate arrangements must be made for handling and recording of prescribed external preparations (e.g. creams) to help ensure they are safely used as prescribed. [Timescale 24/11/08 not met.] 31/03/09 Timescale for action 14/01/09 Bishop`s Court DS0000059340.V373614.R01.S.doc Version 5.2 Page 29 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 OP3 Good Practice Recommendations The manager should monitor care records to ensure that they are legible at all times. This will help to ensure clear information about the persons and the support they need is readily available. Staff should be consistent when completing care records and ensure all the action needed to support people’s health and personal care needs (for example for medication review or continence support). This will avoid information being overlooked and help to ensure that staff have the all guidance they need to support people properly and safely. There should be consistency in recording information and advice from health care professionals to reduce the risk of information becoming lost. Where several doses of medication are missed GP advice should be sought and recorded to help ensure people receive the best treatment. Consideration should be given to the times that medicines are given to help ensure they are - as far as possible - offered at both the right and best times for people. Discussions should be held with the staff team as to the importance of always talking to and about people in an adult manner and the effects this can have on those they support. This will help to ensure people are treated in an adult, respectful manner at all times. One person’s clothing was in poor condition and should be replaced to protect the person’s dignity. This person’s special needs regarding damaged clothing needs to be addressed in the individual’s care plan and clothing should be replaced as necessary. More outings into the local community should be DS0000059340.V373614.R01.S.doc Version 5.2 Page 30 2 OP7 3 OP8 4 OP9 5 OP10 6 OP10 7 OP12 Bishop`s Court arranged for the people living at Bishop’s Court. This will help to support people with the things they enjoy doing and provide them with an opportunity to become more involved with and part of their local community. 8 OP12 The staff should consult with the people living in Bishop’s Court about the meals provided and alter menus based on their choices. This will enable people to have more direct control over their everyday lives. More attention needs to be given to the way people are supported at mealtimes because, due to the way meal times are managed there is a lack of consistency in the way people are given support with their food. Care plans for people’s cultural and religious needs should be up dated regularly and as new information is obtained. This will help to make sure, that as far as possible the home are supporting people with their chosen diet and lifestyles. Careful consideration should be given as to whether it is appropriate to provide Halal meat for everyone living at Bishop’s Court, as is currently the case. The personal, cultural and religious needs of everyone who lives in this home should be accounted for when purchasing meat supplies. Staff should also ensure that this information is freely available to people who are considering moving into Bishop’s Court. To ensure that people are served their meals and assisted without delay, it is recommended that a review of people’s support needs in this be carried out and arrangements for meal sittings and staffing made to support them properly in a relaxed atmosphere. All staff should receive training (updates) in safeguarding to ensure they have the skills to protect people where abuse may be suspected. The broken bath chair should be repaired to ensure that that people can be assisted safely when bathing. An action plan with clear dates should be drawn up to ensure all information required about staff is available within the home. This will help to ensure that the findings of the recent staff file audit are fully implemented. It will also help to ensure all staff are DS0000059340.V373614.R01.S.doc Version 5.2 Page 31 9 OP12 10 OP14 11 OP14 12 OP15 13 OP18 14 15 OP22 OP29 Bishop`s Court suitable to work with the people living at Bishop’s Court. 16 OP30 An overall staff training needs analysis should be drawn up. This should take into account the different needs of the people living at Bishop’s Court. Once this is completed an overall training plan should be drawn up. Clear records should be maintained of all training undertaken by staff. This will help to ensure staff receive appropriate training to support the people living at Bishop’s Court safely and well. The manager of Bishop’s Court should apply for registration with the Commission for Social Care Inspection, as required by the Care Standards Act 2000. Different ways should be explored to obtain the views of the people living at Bishop’s Court. Staff should establish the best way to support people to contribute their thoughts in a way that can be used to help plan future improvements to the service. This planning should follow good practice guidance for working with people who have dementia. 17 OP31 18 OP33 Bishop`s Court DS0000059340.V373614.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North West Region Unit 1, Level 3 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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