Inspection on 14/04/08 for Bishop`s Court

This inspection was carried out on 14th April 2008.

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

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

Other inspections for this house

Bishop`s Court 13/07/09

Bishop`s Court 13/01/09

Bishop`s Court 17/10/08

Bishop`s Court 01/07/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bishop`s Court Sefton Park Care Village Sefton Park Road Liverpool Merseyside L8 3SL Lead Inspector Mrs Trish Thomas / Ms Lorraine Farrar Key Unannounced Inspection 14th April 2008 14:30 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.V362034.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.V362034.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 vacant post Care Home 41 Category(ies) of Dementia - over 65 years of age (41) registration, with number of places Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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 8th June 2007 Date of last inspection Brief Description of the Service: Bishops 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 with dementia. The building is modern, purpose built and provides ground floor accommodation. Bishops Court has pleasant grounds, parking facilities and a courtyard garden. Residents have single bedrooms, twenty-two having ensuite facilities. Bishops Court is close to Liverpool city centre, to local shops and public amenities. Bishops Court is owned by European Wellcare Homes Limited, and the post of manager was vacant at the time of the visit. The fees per week in Bishops Court range from £379.98 to £508.78. Bishop`s Court DS0000059340.V362034.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 who use the service receive poor quality outcomes. The methods we (the commission) used during this inspection are as follows. A visit was carried out during the afternoon into the night shift of 14th April 2008. Discussion took place with the general manager, Mr. Tommy Smith, as currently there is no manager in Bishops Court. Residents, visitors and staff were spoken with and a short observation was carried out to find out residents’ experiences in Bishops Court. Records compiled in Bishops Court about care, health & safety, complaints and staffing were read and four care plans were tracked to find out the ways by which support is provided, risk assessed and reviewed. A tour of the premises was carried out. The annual quality assurance assessment is a self-assessment form, which was filled in by staff, and returned to CSCI before the inspection took place. This has provided information about how Bishops Court is run, plans for future development of the service, and barriers to improvement. Two CSCI relatives’ questionnaires were returned to us and the comments are included this report. Seven of Bishops Court relatives’ quality assurance questionnaires were read and these are also referred to. What the service does well: Bishops Court is an established, purpose-built care home set in quiet surroundings. The service is provided on one floor and there is an enclosed garden, which is ideal for people who have dementia as it provides a secure outside space directly from the main building. Before people move in to Bishops Court, staff have met with them and carried out an assessment of their health and personal care needs to ensure that the service can meet their needs. A relative wrote in a quality questionnaire, “I think the young girls and men are doing a very caring job the way they speak to them and laugh with them. Without them, I don’t know what I would do, because I couldn’t cope.” Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Bishops Court has not had consistent leadership over a twelve-month period as three managers who were appointed have left to work elsewhere. There was no evidence during this visit that the quality of life for residents has improved significantly in the past twelve months. For people who live in Bishops Court, there is little emphasis on equality and diversity in the service, or of promoting their rights and choices. Practices adopted, such as ignoring residents’ requests, restraining them from freedom of movement and covertly administering medication, is evidence that staff lack awareness of the indicators of abuse and of “whistle-blowing” procedures. Requirements from previous inspections have not been met and this has resulted in ongoing complaints and limitations to residents’ quality of life. Requirements from this visit have been made with regards to the protection of residents of Bishops Court. To overcome the continuation of a poor quality service, and to eliminate ongoing risks to the health and safety of people who use the service, the following action is to be taken. Outcomes of safeguarding investigations and complaints are to be monitored and action taken to improve the service accordingly. Staff training in safeguarding is to be updated to give them the knowledge and skills to identify ongoing abuse indicators and risk to residents’ safety and to report them. Also, it is recommended that a copy of Bishops Court complaints procedure will be given to each resident and their representatives. In this way they will be reassured that their complaints will be taken seriously and acted upon. In tracking care plans we found that a lack of detailed ongoing reviews means that people may not be getting all of the support they need to remain as healthy as possible. A requirement is given to ensure that residents’ health is not placed at risk. Care plans are to be regularly reviewed and the outcomes followed at all times and staff are to be reminded of their responsibility in this during supervision sessions and handovers. We found that residents were not receiving individualised support for continence, and a requirement is given that residents’ continence needs are to be reviewed and support given accordingly. Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 7 We found that there is no guidance for staff to follow in supporting people who may become agitated and/or present repetitive forms of behaviour due to dementia, and a requirement from the last visit is repeated. To ensure that residents’ behavioural needs are supported in Bishop’s Court, support plans are to be written to guide staff in the action to be followed to minimise episodes of agitation for each individual who presents this behaviour. By meeting this requirement, the quality of life for all residents will be improved and a more relaxed environment will be maintained. We found that residents’ clothing is going missing and that staff are giving them other people’s clothes to wear. A requirement from the last inspection has not been met and is repeated in this report. To ensure that residents’ dignity is reflected in their appearance, the condition of their clothing, to be reviewed, and arrangements made to replace clothing as needed. A visitor said her relative often wears other people’s clothes and another stated in a questionnaire that she is dissatisfied with the laundry and has spent a lot of money replacing clothes. To ensure residents receive social support which meets their individual needs, a requirement is repeated from the last inspection that, consultation is to take place with all service users and/or their representatives and facilities be provided for daily recreation inside and outside of the home. A resident said there is nothing to do all day but sit. A visitor said the brochure states the Bishops Court has a mini bus but her relative has never been out. We found that the people living at Bishops Court had been placed at serious risk due to ill-fitting bedrails. It is a matter of concern that staff had not identified the risks and taken action to address them. A requirement is given to ensure that bedrails will be regularly checked to ensure they meet safety guidelines and are suitable for residents. To ensure that residents are able to go outside, a risk assessment is required of the rear garden and appropriate action is to be taken to remove trip hazards. This specifically relates to the identified hazards in the enclosed garden area and is repeated from the last inspection. A recommendation is made that the service user guide be updated to give a full account of the services in Bishops Court. In this way people will have plenty of knowledge to inform the decision as to whether this home will be suitable, before moving in. Please contact the provider for advice of actions taken in response to this Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 8 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.V362034.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.V362034.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): Quality in this outcome area is good. People have had their health and care needs assessed before they move in, however they are not given the up to date information, which will help them make the decision as to whether Bishops Court will be a suitable home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 1 and 3. Before anyone moves into Bishops Court, staff will visit them and carry out an assessment of their needs and choices. People are invited to visit Bishops Court before moving in to meet people who live there and staff. A care file, which was read, contained a written assessment and a care plan, which had been signed by the resident to show he/she was involved, and that consent to the care plan has been obtained. Staff of Bishops Court had visited the person at their previous home and the assessment, which they carried out, gave details of the person’s mental and physical health, preferred activities, Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 11 religion, lifestyle and choices. In this way the person’s support needs had been recorded before moving in, and a plan could be set out as to how assessed needs will be met in Bishops Court. Bishops Court does not currently have an up to date guide to give information to people about the service. We were advised that plans are in place to provide one and a recommendation is given that these plans are implemented. Once completed, people considering moving in, will have plenty of knowledge to inform their decision as to whether Bishops Court is the right place for them to live. A visitor said that the home’s brochure states that Bishops Court has a mini bus for residents to go on outings, but her relative has never gone out since moving in to the home several months ago. Bishop`s Court DS0000059340.V362034.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): Quality in this outcome area is poor. Residents’ dignity, rights and diversity are not always respected in Bishops Court and arrangements for care giving are unclear which could place people’s health at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 7,8,9,10. Everyone living at Bishops Court has an individual plan of their care in place, which has been reviewed regularly. However it was clear that care plan reviews do not always reflect the support and advice provided to the person in the previous month. For example one person had advice from the NHS to eat a normal diet and un-thickened fluids. However a later plan review, by staff at Bishops Court, stated that the person was to remain on a soft diet and thickened fluids. This lack of detailed reviewing of care plans means that people may not be getting all of the support they need to remain as healthy as possible. Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 13 Records showed that people are weighed regularly and if needed their blood sugar levels are recorded. However it was unclear what action to take as a result of this. For example one person had lost 3.3 kilos in a month, however there was no record of any action to address or monitor this. Similarly records showed that one person’s blood sugar levels varied considerably. There was no record of what (if any) action should be taken, based on the person’s individual needs. This lack of action on recorded information could put people’s health at risk. We sampled records of how the home supports people with pressure sores. These showed that advice is sought from the NHS and District Nurses. However records are held in different places. We were unable to establish a clear picture of how the pressure sores had developed over time. This lack of an easy to access audit trail could result in people not getting the support they need with their health. We looked at how medication is managed in Bishops Court for some of the people living there. Medication was stored correctly and a clear audit trail in place as to how much medication had been received into the home and given to people. This helps to lessen the risk of a mistake with people’s medication occurring. A short observation carried out during the night medication round gave evidence of covert administration of medication for two residents. This is contrary to the rights of those people who both have dementia. This matter was discussed with Mr. Smith, who said he was not aware that multiple tablets were being given at once to a resident, or being mixed with food for another person. He said this is against the company’s medication procedures. Mr. Smith said he would make sure that medication procedures are followed correctly in future and provide training to ensure staff will follow best practice in this. A short observation carried out in a lounge during the evening shift showed that requests made by two residents were ignored and that a member of staff restrained a resident by the wrists on five occasions, because this person wanted to get up and go for a walk. When the person stood up from the chair, the comment from staff was, “Sit down,” on three occasions. One of the people living at Bishops Court told us that they think the staff are, “Nice” and that they always respond quickly to request for help or to the call buzzer. A relative wrote in a quality questionnaire, “I think the young girls and men are doing a very caring job the way they speak to them and laugh with them. Without them, I don’t know what I would do, because I couldn’t cope.” Following concerns raised with us about a lack of continence pads, underclothes and nightwear in Bishops Court, we looked at the availability of these for four of the people living there. We found that most people did not Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 14 have sufficient nightclothes and underwear to use over night, particularly if they needed to get changed. A member of staff said that if this occurs they have some ‘communal’ nightclothes and underwear. She acknowledged that this was not ideal, but explained it was the only option available. Similarly although there were a number of packs of incontinence pads available they were all the same size. No net underwear was available to ensure these remained in place. A member of staff confirmed that the pads were not suitable for everyone and there for people needed to get changed in the night due to incontinence. This not only results people having disturbed sleep, it also compromises their rights to be treated with dignity and respect. The relatives of a resident were spoken with during the visit. They said they think the care and support to their relative is satisfactory. They were not satisfied with loss of clothing and that this person is often given other people’s clothes to wear. They said they know this because they collect her clothing for laundering as so much had gone missing when this was done in-house. They said there is often clothing amongst her own items for laundering, which do not belong to her. Relatives also commented on this in quality questionnaires and some of their comments are as follows, “I hope this home will get its own laundry room. It will help residents look better in their own clothes and should also help staff. No matter how many labels are sewn into clothes they still go missing.” “I am still very dissatisfied about my (relative’s) clothing. Even after replacing clothing which has gone missing (name) only ever appears to wear his own pants and other people’s clothing.” Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is poor. Although some activities are arranged, residents of Bishops Court seldom go out, there is a task centred culture and their choices, diversity and beliefs are not fully supported. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 12,13,14,15. Care records for the people living at Bishops Court, record some information about the things people like to do. However this is not always followed. For example one record stated the person should be invited to go on trips out, however no trips out had occurred in the past couple of months. Similarly another record stated the person should be supported with their religion. A member of staff was able to explain some steps she had taken to organise this. However nothing had actually been arranged. A lack of recording action taken and plans to provide the support required may mean that people never get the support they want with their lifestyle needs. Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 16 Several activities had been arranged in house such as parties, buffets and race days. These provide people with some interest during their day. However one lady told us that she would like to do more things such as exercises and said, “There’s nothing to do all day but sit”. Good recording around individual discussions with people did show that staff are aware of people interests and hobbies and spend time talking with them about these things. A short observation was carried out in the dining room. The evening meal (chicken curry and rice), looked appetising. This was served from a hot trolley and portions served were substantial. Some residents were asked what they would like and were offered an alternative. Some people waited nearly an hour for their food, as the more dependent residents who are less able to complain or choose when to eat, were served last of all. Some people were moving from their tables while they were waiting, which distracted those who were eating. Three care assistants supported residents in the large dining room. A further member of staff was serving meals through the service hatch. The small dining room was visited. A member of staff was supervising three highly dependent people. A person was calling repetitively for a cup of tea and was ignored by staff. The situation could have been avoided by planning the person’s support in all aspects of daily life, including meal times. People were eating their meal, whilst a person was constantly calling out in a loud voice, this did not provide a relaxed environment. A requirement (repeated from the last inspection) regarding support plans for people’s behaviour is given under standard 7. The outcomes of the observation showed that some of the staff showed empathy with residents and had positive contact during the meal. Others have a more passive attitude towards them by either ignoring them or taking less care to consult or inform them of what was happening. It is recommended that mealtimes be observed and reviewed by senior staff to find ways of improving the standard of service for people. A relative wrote in a quality questionnaire, “We have never seen a menu. Have only seen (name) eating in the dining room. She can never tell me what dinner she has had. “ Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. Remedial action has not been taken to upgrade the service in accordance with the outcomes of complaints and safeguarding investigations, resulting in no significant improvement in residents’ quality of life over recent months. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 16 and 18. A record of complaints in Bishops Court shows that three complaints have been raised about the laundry service provided and people’s clothes going missing. Records showed that these concerns have been investigated and where they were upheld, compensation had been given. The company have audited the laundry service and found that many items are not returned to Bishops Court from the communal laundry, which is shared by three homes in the group. We were informed that there are plans to provide a laundry for the sole use of Bishops Court by converting a vacant bedroom. We were also told of this plan during the visit of December 2007, and it has not been acted upon to date. The current laundry arrangement of using the shared facility is clearly not providing people with the service they expect. Complaints and comments of dissatisfaction have been continuous and the absence of remedial action has resulted in an ongoing lack of respect for residents’ dignity and possessions. Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 18 Records for one person showed that a resident at times enters other people’s bedrooms. No risk assessment around this was available to state how the staff intend to protect the others living there from what they may see as an invasion of their privacy. A senior manager for the company stated he intends to make the complaints procedure readily available to people living in Bishops Court and their relatives. A recommendation is given that this plan is to be implemented. This will ensure people are fully aware of the action they can take if they have concerns about any aspect of the service. Staff have received some training in adult protection and copies of national and local guidelines are available in Bishops Court. Practices adopted in Bishops Court, such as dressing people in the clothes of others, ignoring them, and covertly administering medication, is evidence that staff lack awareness of the indicators of abuse and “whistle-blowing” procedures. There have been five safeguarding referrals about Bishops Court in the past twelve months, these have been with regards to concerns about pressure care and injury, and have been upheld. Concerns raised with us about lack of continence aids, shortage of clothing and bedding for residents, shortfalls in medication procedures and of poor heating at night, were looked into as part of the inspection process. The outcome is that Regulations have not been met and requirements will be given to ensure that improvements will be made accordingly. Regulations had been met regarding cleanliness of the building and moving aids although patienthandling training for some staff needed updating. Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate. The building is clean and in good decorative order but lacks the orientation aids, which are helpful to people who have dementia, and the garden is unsuitable for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 19 and 26. All areas of the home were clean and tidy during our visit and we noted that people are able to personalise their bedrooms with their own possessions if they wish to do so. The majority of areas of the home have been decorated recently with plans in place to decorate all other areas shortly. This helps to provide a more pleasant environment for people to live in. Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 20 Senior management were able to provide evidence that action is being taken to replace some furniture, establish a laundry and address concerns regarding heating. Once these things are in place they will further improve the environment. There was little in the way of orientation aids in the environment for people living there. A manager from the company advised that they are aware of the need to provide a more specialist environment suited to the needs of the people living in the home. He stated that plans for an expert in ‘supporting people with dementia’ to visit the home and give advice, are in place and that this advice would be followed. It is recommended that orientation aids are to in place throughout the home for residents’ interest and assistance. The home provides some aids and adaptations to support people with their personal care and mobility. This includes call bells, bath chairs and grab rails. As all areas of the home are at ground level this makes it easier for people to get around. The section on management of the home at the end of this report deals with areas of risk identified with aids during our site visit. . There are currently five bath or shower rooms in Bishops Court. However during our visit one was used as a storage room and a second was being altered into a treatment room. This would leave a ratio of three bathrooms for forty people. National standards for supporting older people state that there should be a ratio of one adapted bath / shower for every eight people. The current arrangements leave one facility for every thirteen people and are therefore a backwards step in supporting people in line with good practice. It is recommended that bathrooms should not to be subjected to change of use A requirement from the last inspection that the garden be made safe for residents by eliminating tripping hazards, remains outstanding. The garden is enclosed by the building, has seating and planting, and could provide a safe and pleasant outside space for residents. Since the last key inspection the garden has been cleared of rubbish and tended and was in fairly good condition at the time of this visit. We were informed by management that fencing was to be fitted, as a barrier to the tripping hazards, and the work was due to be carried out during the week after the visit. Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is adequate. The service does not support the development of a competent staff team and there is a lack of respect for residents’ diversity, human rights and dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 27,28,29,30. Senior managers for the organisation told us that they have been looking at the numbers of staff they provide and as a result have increased staffing levels at night by one care assistant. This was seen to be in place during our visit and one of the people living there told us that they get a quick response from staff when they need support. Bishops Court currently uses a high number of agency staff. For example on the night of our visit, three of the four care staff were from an agency. Although there is use of regular agency staff this can result in an unsettled staff team who cannot provide a consistent service to the people living there. Records showed that the company have begun a recruitment drive and were interviewing staff for a range of posts during our visit. Once this is completed the people living there will be able to receive more consistent support from staff they know with and who are familiar with how Bishops Court operates. Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 22 Staff files did not contain all of the information needed to prove that the company have carried out as many checks as possible to ensure staff are suitable to work with people who may be vulnerable. For example, no recent checks had been carried out to ensure existing or newer Nurses were registered as fit to practice as Nurses. Not all files had evidence that Criminal Records Bureau checks or checks on the Protection of Vulnerable Adults register had been carried out. Satisfactory references had not always been obtained for staff from their last employer. Where references did not provide sufficient information or were negative, there was no evidence that this had been followed up. This lack of rigorous checking of staff may lead to people being supported by staff who are unsuited to the work and therefore may place people at harm. Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is poor. The service has lacked consistent leadership over a twelve-month period, which could pose significant risk to residents of Bishops Court. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 31,33,35,38 The registered providers have appointed managers for Bishops Court and there have been three managers over a twelve-month period all of whom have left. None of the managers has been registered with CSCI. Mr. T. Smith is the general manager currently overseeing management of Bishops Court until a manager and deputy are appointed. Mr. Smith has drawn up action plans to Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 24 address areas and issues of concern he has identified, no action to address these had yet been fully implemented. Seven relative’s quality questionnaires dated November 2007, which had been distributed by staff via the organisation’s Quality Assurance procedures, were read. The findings were these: A relative who lives out of the area and does not visit very often said, “It is difficult for me to assess this service as I live away and visit infrequently. You could email details of results of reviews of clients and newsletters to relatives. ” A relative wrote, “I hope this home will get its own laundry room. It will help residents look better in their own clothes and should also help staff. No matter how many labels are sewn into clothes they still go missing.” A relative wrote, “We have never seen a menu. Have only seen (name) eating in the dining room. She can never tell me what dinner she has had. “ A relative wrote, “My only problem is gaining access to my mum’s room, obviously the staff are very busy but I find that my mum is best when things are one to one.” A relative wrote, “I am still very dissatisfied about my husband’s clothing. Even after spending a lot of money replacing clothes lost at (name hospital) and Bishops Court, he only ever appears to wear his own pants and other people’s clothing.” A relative wrote “More staff, more one to one.” On the tick box sections, those who filled in these questionnaires stated satisfaction with care and support and quality of life for their relatives. We discussed management of finances with a senior manager, employed to improve standards in Bishops Court. He told us a draft procedure has been submitted to CSCI, regarding finance management. He said the procedures have to be adopted nationally so will not be fully implemented until approved. Regarding personal allowances, we queried charges for cigarettes, which do not state the amounts provided for the money deducted and there are no receipts. Staff said the cigarettes are bought in bulk from a supermarket. We advised staff that all items and amounts for which money is deducted must be made clear in each person’s account. During our visit we audited the use of bed rails in Bishops Court. Four people had bedrails fitted to their beds. Some of these had mattresses smaller than the bed base and bumpers for the rails that were not only frayed but also lacked fasteners. All four bedrails were identified as a serious risk to people due to their ill-fitting nature. Gaps were present in each that could cause someone to become trapped and suffer a serious injury. The company Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 25 arranged for extra staff to work overnight and put steps into place to ensure the safety of the people living there. They subsequently advised us that they had replaced these rails with beds that comply with good practice guidance and legislation. However the people living at Bishops Court had been placed at serious risk and it is a matter of concern that staff had not identified this and taken action to address it and a requirement is given to ensure that bedrails are safe in future. Many of the people living in Bishops Court need aids and adaptations to support them with their mobility. A new hoist had been provided which staff advised us they use. However a bath chair that is used for people had not been tested, within the past twelve months to establish its safety for people to use. No training had been provided to staff in the past year on how to move people safely and well. This lack of equipment testing and training for staff could place both the people living and working at the home at risk of injury. Records and certificates showed that regular tests are carried out on fire equipment and that the gas supply has been tested. However records for tests of the electrical system, small electrical appliances and any lifting equipment could not be located. The lack of available records may mean that the premises and equipment are not as safe as they should be and place people at risk. As proof that safety checks have been carried out, it is recommended that copies of up to date safety certificates are provided to CSCI. A number of residents were seen to have injuries during the visit and although such incidents had been recorded, there was no evidence that accidents have been monitored and risk assessed and a requirement to ensure that risks to residents are identified and addressed. Notifications to CSCI required under Regulation 37 have not been received and a requirement is given to ensure that we are informed of the instances and occurrences referred to under this Regulation. Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 26 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 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 2 X X 1 Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? 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 OP19 Regulation 23 Requirement A risk assessment in relation to the rear garden area to be made with appropriate action taken as a result of the risk assessment. This specifically relates to the identified trip hazards in the enclosed garden area. (Repeated from the last inspection, extended time limit given). By meeting the requirement a safe outside space for residents will be available. Continence assessments to be carried out for all residents, and people are to be provided with pads, aids and continence plans accordingly. To ensure that residents are not placed at risk, health care plans are to be regularly reviewed in detail and are to be followed at all times and staff should be reminded of their responsibility in this during supervision sessions and handovers. (Repeated from the last inspection, extended time limit given). DS0000059340.V362034.R01.S.doc Timescale for action 30/06/08 2. OP8 15 30/06/08 3. OP8 15 30/06/08 Bishop`s Court Version 5.2 Page 28 4. OP9 13 5. OP10 12 To ensure that staff are competent to administer medication safely and in a way which respects residents’ rights and dignity, they are to receive relevant training. To ensure that residents’ dignity is reflected in their appearance, the condition of their clothing, to be reviewed, and arrangements made to replace clothing as needed. (Repeated from the last inspection, extended time limit given). To ensure that residents’ behavioural needs are supported in Bishop’s Court, support plans to be written to guide staff in the action to be followed to minimise episodes of agitation for each individual who presents this behaviour. (Repeated from the last inspection, extended time limit given) To ensure residents receive social support which meets their individual needs, consultation is to take place with all service users and/or their representatives and facilities be provided for daily recreation inside and outside of the home. (Repeated from the last inspection, extended time limit given). For residents’ protection, staff are to receive safeguarding training, to ensure they are aware of the indicators of abuse and the actions to be taken to report suspected abuse. The registered person to give notice to CSCI of incidents and occurrences in the care home, referred to under Regulation 37. DS0000059340.V362034.R01.S.doc 30/06/08 30/06/08 6. OP7 15 30/06/08 7. OP12 16 30/06/08 8. OP18 13 30/06/08 9. OP38 37 30/06/08 Bishop`s Court Version 5.2 Page 29 10. OP38 13 11. OP38 13 12. OP29 19 13. OP30 18 14. OP30 18 For residents’ protection, the accident book to be monitored and risk assessments carried out accordingly. (Ongoing from the date given). For residents’ protection bedrails are to be checked regularly to ensure they meet safety guidelines and do not pose a risk to each person. (Ongoing from the date given). For residents’ protection, staff are to be suitably vetted before taking up their post, and suitability of nursing staff regularly monitored by checking PIN numbers. (Ongoing from the date stated). To ensure that staff have the skills needed to support residents of Bishops Court, training to be reviewed and updated. (Ongoing from the date given). For residents’ protection, staff are to be given training in dementia care. 30/06/08 30/06/08 30/06/08 30/06/08 30/06/08 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 OP1 Good Practice Recommendations The service user guide is to be updated to give a full account of the services in Bishops Court. In this way people will have plenty of knowledge to inform the decision as to whether this home will be suitable. To ensure that residents are treated with respect in all aspects of their life in Bishops Court, staff are to be instructed in promoting the principles of dignity, rights and DS0000059340.V362034.R01.S.doc Version 5.2 Page 30 2. OP10 Bishop`s Court 3. 4. 5. OP10 OP15 OP16 choice when supporting residents. To ensure that residents’ clothing is returned after washing, it is recommended that a laundry be set up for the sole use of Bishops Court. To ensure that mealtimes are relaxed and that people are served without delay, it is recommended that a review of meal times is carried out. To ensure that residents and their representatives know their complaints will be listened to and acted upon, it is recommended that they be given a copy of the complaints procedure for Bishops Court. It is recommended that remedial action is taken in response to the outcomes of complaints which are upheld. In this way, the service will improve and complaints will not be repeated. To ensure that residents have sufficient bathing facilities it is recommendation that bathrooms are not subject to ‘change of use’ plans. To ensure that the building is well heated it is recommended that the new boilers be fitted. To ensure that the environment is suitable for people who have dementia it is recommended that orientation aids be replaced. It is advised that a manager be recruited for Bishops Court to ensure that staff have the guidance and support they need. To ensure there are safeguards in place to protect the interests of residents, it is recommended that records of expenditure are supported by detailed receipts for the goods which have been charged for. To ensure that staff have guidance as to how residents’ social, emotional and mental health needs will be addressed, it is recommended that these needs be reviewed and detailed relevant support plans be written. To give proof that safety checks have been carried out, copies relevant up to date certificates to be provided to CSCI. 6. OP18 7. 8. 9. 10. OP19 OP19 OP19 OP31 11. OP35 12. OP7 13. OP38 Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Regional Contact Team Unit 1, 3rd Floor 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.northwest@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bishop`s Court DS0000059340.V362034.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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