Inspection on 17/10/08 for Bishop`s Court

This inspection was carried out on 17th October 2008.

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 13/01/09

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 19/12/2008.

CARE HOMES FOR OLDER PEOPLE Bishop`s Court Sefton Park Care Village Sefton Park Road Liverpool Merseyside L8 3SL Lead Inspector Trish Thomas Key Unannounced Inspection 17 October 2008 10:30 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.V369800.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.V369800.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.V369800.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 1 July 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.V369800.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 17 October 2008. Four inspectors, including one of our pharmacy inspectors, carried out the visit. We spoke with the newly appointed manager of the home and the general manager who has been overseeing the home for the past six months. 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, 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 live at the home in detail and then tracked the care they were getting to make sure they were receiving the care to meet their needs safely. We also checked that the care records were up to date and gave clear guidance to staff about what they had to do to meet people’s needs. We spoke with people living in the home to find out about their experiences there. We also spent time with them in the lounges and carried out a short observation in the dining room whilst a meal was being served. The views and experiences of people who live in the home are included in this report. 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 person who lives in Bishop’s Court told us, “I like my new bedroom, it has everything I need.” A person who was visiting the home whilst we were there said she has seen a number of improvements in Bishop’s Court over recent months. Bishop`s Court DS0000059340.V369800.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? During recent months a number of managers have been appointed and then left Bishop’s Court so the general manager has been overseeing the home. This had led to more consistency in the management of the home recently so that the quality of the service for people who live there has been improved. More work is in progress and work will need to continue to raise standards further to improve quality outcomes for people who live in Bishop’s Court. A manager has been appointed and will be applying for registration with the commission. The general manager will remain in a support role to assist the new manager so that the improvements in the service for the people who live at the home can be continued. The service user guide for the home has been amended so it gives information that is specific to Bishop’s Court. This document now gives people the information they need to help them decide if the home is suitable to meet their needs. A new form has been drawn up for staff from the home to use when they visit people who are interested in moving into the home, to find out what sort of support they need. This will help them to make sure they have information about each person’s health, personal care needs, cultural and leisure needs and record it. This means that there is information to show that the person’s needs can be met at Bishop’s Court, before they move into the home. Action had been taken to improve the management of medicines and to make sure that the problems we have found previously have been dealt with. Although there are still some weaknesses, these have been identified and are being dealt with through regular checks of the medications. The management team is continuing to monitor the management of the medicines to make sure that improvements continue. Staff now have a written medication policy to refer to and assessments are done of their competency to make sure people living at Bishop’s Court receive their medicines safely, as prescribed. Consultation on activities and outings for people who live at the home is taking place to make sure there are regular opportunities for people to socialise and take part in activities that interest them. We found that steps had been taken to improve conditions in the dining room. New cutlery and crockery has been purchased and tables are laid properly before people sit down to eat. Staff have received training to help them provide discreet and respectful help for people with their meals so that the experience of mealtimes has become more pleasant and enjoyable for the people who live at the home. We had made a requirement for staff to receive training about safeguarding adults from abuse and at this inspection we found that staff we spoke with were clear about what they had to do if they thought people at the home were Bishop`s Court DS0000059340.V369800.R01.S.doc Version 5.2 Page 7 being abused. Clear information is available for people about the investigative procedure for managers to follow to make sure that concerns are dealt with quickly and people are protected. Bedrails in use in the home are now checked regularly and new bumpers have been fitted to protect people who are using them from getting trapped or injured. Staff recruitment records we saw showed that thorough recruitment procedures are now being followed with all the required checks being carried out to make sure staff are suitable to work with the people who live at the home. A chart has been drawn up to record basic staff training so refresher training can be made available to make sure that staff have up to date knowledge and skills to meet the needs of people who live at Bishop’s Court safely. Staff told us that a number of training events have taken place recently in basic areas of care such as moving and handling as well as more specialist areas such as supporting people with dementia. Care staff told us they have a lot of support from manager and they were clear about how they communicate information about the support needs of the people living there. This helps to ensure that people receive a consistent service and that their needs and choices are identified and met. The staff we spoke with were keen to support people well and to improve the service provided at the home. What they could do better: Work has progressed on transferring the care plans to a new format that will be easier to follow and give staff clear guidance on how they should provide care and support for the people who live at the home. This needs to continue to make sure that the gaps we found in care plans that we looked at are dealt with so that each person has a full care plan that shows how their needs should be met to protect their wellbeing. There continues to be a lack of information about the correct use of medicines that are prescribed to be taken ‘when required’. Individual guidance about the use of these medicines needs to be provided to make sure that people living at the home receive their medicines safely. Staff we spoke with told us that people who live at Bishop’s Court enjoy going out and about and they think more planned outings would improve the service they provide, so people could take part in social activities that they enjoy. Although we saw that people’s experiences at mealtimes were much improved, there were still problems for some. A review of people’s support needs at mealtimes is needed to make sure there are enough staff to help people living Bishop`s Court DS0000059340.V369800.R01.S.doc Version 5.2 Page 8 at the home individually, without delay, to improve their experiences of mealtimes. Although some staff training is taking place and some records have been made, there is still no overall plan for this training or who received training. For example, some staff recently received training on tissue viability but we saw no records of this. An overall training plan and record is recommended, to help to identify more specialist training to make sure that staff can meet the needs of people living at Bishop’s Court. The questionnaire used at Bishop’s Court to find out what people think about the service does not meet guidelines for working with people with dementia and we have recommended that steps are taken to find different ways of supporting the people who live at the home to express their thoughts about the way the home is run and how it could be improved for them. There were no clear records available as to why the organisation act as appointee for people and how the decision was reached. There was also no explanation available on file in the home about how the company manages the money for those people it is appointee for. People who live in the home and their representatives should have a clear explanation about how their money is being managed for them by the company. 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.V369800.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.V369800.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. There are systems in place to ensure that people have up to date information and have their needs assessed before they move in to Bishop’s Court, to help them make a choice about whether this will make a suitable home. EVIDENCE: The information about Bishop’s Court in its service user guide has recently been reviewed and improved to make it specific to the home. It contains information about the service aims and objectives, staff qualifications, the facilities available and the fees. It is available in easy read format, large print and Braille to help people to read it more easily. The updated guide has been given to people currently living at the home to make sure they have full information about their home. Bishop`s Court DS0000059340.V369800.R01.S.doc Version 5.2 Page 11 Before a person moves in to Bishop’s Court, their needs and preferences will be assessed so that staff will know the person’s needs can be met at the home. Staff carry out the assessment with the person (and their representative present), in their own home or in hospital. They do this by asking the person about themselves and recording the information on an assessment form. The form has recently been reviewed and improved to include more information about the person’s wishes and feelings on what they like to do and how their support should be given. We could not see whether this new document was going to be effective as Bishop’s Court was not accepting new residents at the time of our visit. The format, if followed and filled in properly by staff, makes provision to find out about people’s health and personal care needs, their culture and religion and leisure needs and preferences. Once the person moves in, the assessment outcomes would be used to form the basis of the person’s care plan. Bishop`s Court DS0000059340.V369800.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. Work to improve the care plans and medication systems has continued since our last visit but staff need to keep accurate records and follow care plans and medication procedures more carefully, to ensure residents’ health and welfare are not placed at risk. EVIDENCE: There is a care plan for each person who lives in Bishop’s Court to guide staff about their individual support needs. Over recent months, care plans have been transferred to a new system to give more information about people’s health, personal care and leisure needs in a format that is clearer and easier for staff to follow. We looked at five care plans and four gave reasonable guidance for staff about each person’s care although some records were incomplete. The other care plan was for a person who was receiving treatment for a pressure wound. The Bishop`s Court DS0000059340.V369800.R01.S.doc Version 5.2 Page 13 care plan did not have up to date information about the size of the wound, which had not been measured since the initial assessment. The information about the type of dressing to be used was written on the evaluation sheet, not the care plan, so staff might have missed this important information. Some of the care files we looked at had incomplete records on risk management. There was no risk assessment to make sure that one person who smokes could do so safely. Staff we spoke with about this knew of the risks and the safety measures to be followed for residents who smoke but these had not been recorded in the person’s care file. In another file we found there was no risk assessment regarding sharp objects although, again, staff know what they should do to manage this risk safely for the person. We found that there were shortfalls in one person’s care plan that could have an impact on their safety. Staff knew about the person’s special dietary needs because of their swallowing difficulties but these had not been recorded in the person’s care plan. The lack of written information about the risk assessments and what needed to be done to reduce risks for people could lead to them being injured or not receiving the support they needed. Staff we spoke with were able to tell us about the individual support the people living at Bishop’s Court need and prefer. They explained that they use daily records and notes to share information amongst themselves. This helps them to make sure that people receive the support that they need and that any changes to the person’s care needs are quickly noted and acted upon. One of the people living at the home told us he receives help with his personal care whenever needed and that routines are flexible to suit him. We looked at the arrangements for handling peoples medicines and found action was being taken to address shortfalls identified at previous inspections. Some weaknesses remain but on the whole these were being identified and addressed through the home’s regular medication audits (checks). We saw that some shortfalls remained right up until the latest medication delivery; the management team said that monitoring would continue to help ensure that any improvements seen are sustained. We saw that a written medication policy had been implemented and was available to staff for reference. Staff competency assessments had continued and this helps to ensure medicines are safely handled so that people receive their medicines as prescribed by their doctors. Medication record keeping had improved so on the whole, it was possible to track the safe handling of medicines in the home. However, we found inconsistency in recording advice from healthcare professions such as doctors. This meant it was not always possible to see when changes to peoples medication had been made. It is important that clear records are always maintained so that where necessary, any changes can be followed-up. It was of concern that we saw one example where the medicines administration record noted that someones tablets had been stopped, but this information Bishop`s Court DS0000059340.V369800.R01.S.doc Version 5.2 Page 14 had not been carried forward to the new monthly records and treatment had re-started. Treatment continued for five days before it was noted through the home’s own audits. Staff at the home do not see the prescriptions before they are dispensed. We recommend they do this, as changes can be queried before medicines are delivered. Care needs to be taken that procedures for checking in the new monthly medicines order account for any recent dose changes. The way that prescribed external preparations (e.g. creams) were handled had been changed with the new delivery, but we found the new system was not working well. Signed records were not completed when creams were applied and it was not possible to tell whether they were being properly used as prescribed. As for all prescribed medication complete, clear and accurate records need to be maintained to support and evidence their correct use. It was of concern that right up to the most recent delivery we still saw examples where doses had been missed because there was no medication left to give. We found that this had been largely addressed with the latest delivery, as changes had been made with surgeries to ensure sufficient quantities were ordered to last the whole month. We found no evidence of delay in obtaining medicines prescribed outside the homes normal monthly order. Nurses explained that medicines could be quickly obtained from the local pharmacy and that staff would wait at the pharmacy if medicines were needed urgently. As seen at previous visits we found there was a lack of information about the correct use of medicines prescribed to be taken ‘when required’. To help ensure consistency, there should be individual guidance about when these medicines should be given. Managers explained this was being addressed as peoples care plans were reviewed. We found that medicines including controlled drugs were stored securely. Regular checks were carried out to check that controlled drugs records were accurately completed. This helps to ensure that they are not misused or mishandled. A visitor told us her relative is well cared for, this person’s clothing is looked after and their personal care needs are well supported by staff. She said she has seen a number of improvements in Bishop’s Court recently. A resident told us that in the past their clothing had gone missing when given to staff for washing, but this doesn’t happen since a laundry has been set up on the premises. She said clothing is brought back without delay and in good condition and that is “great”. Staff who work in the laundry confirmed that each person has a supply of individual bedding and towels that are returned to their bedrooms after laundering. Each person’s clothing is marked with his/her name to make sure it its returned directly to the right person after laundering. Bishop`s Court DS0000059340.V369800.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): 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 are arrangements in place for in-house activities and conditions in the dining room have improved but further improvements are needed to ensure that people have the social support they need and better support with their meals. EVIDENCE: There is an activities co-ordinator employed for forty hours a week to provide in house leisure events and outings for people who live in Bishop’s Court. Staff told us that consultation is in progress to find out what activities people like to do. Because many of the people living in Bishop’s Court have memory and communication difficulties, it has been necessary to contact their families about this. When information is received from the families, each person will have an essential lifestyle plan written for them. Activities will then be arranged for each individual, according to their stated abilities and preferences. Bishop`s Court DS0000059340.V369800.R01.S.doc Version 5.2 Page 16 In one lounge, we saw people enjoying a board game with staff whilst in another, people were listening to a story on tape. Staff said some sort of activity is provided every day and we were told that there had been a “hand massage session” during that morning. The activities co-ordinator said she keeps a record of social events that take place in the home and makes a note of what is popular with people. The activities plan we saw showed what was on offer for people each day including reminiscence sessions, hairdressing, bingo, manicure, hand massage and stories from the talking book. There was no recent evidence of people going on outings, although we were told some went of a trip to Blackpool in the summer and a trip to Blackpool lights is under discussion. Two residents said they would like to go out more regularly. One person appreciated the improvements which have been made in the courtyard garden which is now safe for people to use.. Staff appeared to be more engaged with the people who live at Bishop’s Court than on our previous visits. For example, previously they had been seen supervising people in the lounges without speaking with them very much. During this visit, there was plenty of conversation between staff and residents, who were being encouraged to take part in what was going on. In general, there was a pleasant atmosphere and people appeared to be relaxed in their home. Staff told us there are religious services held on site and residents will be helped to take part, if that is what they want. One person said that staff help her to be part of her religious community through attending a nearby social club. A person who was visiting the home when we were there told us there are no undue restrictions on visiting times in Bishop’s Court and staff are always polite and helpful during her regular visits. For people who have no family and/or are in need of independent support, the service user guide gives information about access to the services of advocates. The dining room has been decorated recently and new dining tables and chairs purchased. Conditions for people during mealtimes have improved, as dining tables are laid with tablecloths, cutlery and condiments and there are two meal sittings for people. We spent an hour and a quarter observing the first lunchtime sitting to see what was happening and if improvements had been made to the way mealtimes are managed for the people who live at the home. Staff told us they have received guidance about supporting people in a way that respects their independence and dignity. Most people who were having one to one support with their meal received an individual service from staff, who sat beside them, enabling them to eat at their own pace. One person was not eating the meal placed in front of her. She did not receive one to one support until another person had finished their meal and a member of staff was free to help her. This person had been one of the first to be brought into Bishop`s Court DS0000059340.V369800.R01.S.doc Version 5.2 Page 17 the dining room, and waited nearly half an hour for her meal having fallen asleep before a member of staff was available. One person did not eat very much of the meal and a member of staff said this information would be passed on to the nurse on duty. A small service room in the home is used to make drinks and snacks. There are stocks held of cereal, bread, and some sandwich fillings. It may benefit the people living at Bishop’s Court if the service room stocked small items to make a basic hot meal. Therefore if someone missed a meal or wanted something to eat later at night a choice would be available. Meals for people living at Bishop’s Court are cooked in a central kitchen on the care home site by qualified cooking staff. Kitchen assistants are employed to help with food preparation and cleaning. The food stores were well stocked at the time of our visit, and catering records were up to date. The cook said that people’s preferences and their cultural needs are taken account of in the menus with alternatives always available. In respect for people’s diversity, cooking staff have been given written guidance on the special diets and feast days observed by people of a number of races and religions. Fridge and freezer temperatures, as well as cooked food temperatures, are taken every day to make sure that food is stored and served at safe temperatures. Bishop`s Court DS0000059340.V369800.R01.S.doc Version 5.2 Page 18 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 procedures and staff training in place for safeguarding and complaints management to make sure that people’s concerns are taken seriously and they are safeguarded from abuse but improvements are needed to make sure that people who the organisation acts as appointee for are protected. EVIDENCE: Information about how to raise any concerns is made available for the people living at Bishop’s Court and their relatives in a poster in the foyer and leaflets. One of the people living at the home told us that if he were concerned about anything he would tell a senior manager, as “he gets things done for us”. Staff receive training in recognising and dealing with abuse of adults. During our visit to the home, we spoke with several staff, all of whom were clear about their role in reporting and dealing with concerns and safeguarding issues that may occur. The level of information provided to the people living at the home, along with clear procedures, helps to ensure that any concerns can be quickly identified and addressed. There was one complaint recorded in the complaints log for the home since our last inspection. This had been about the quality and presentation of the food Bishop`s Court DS0000059340.V369800.R01.S.doc Version 5.2 Page 19 being provided from the central kitchen and the records showed that management investigated and took effective action to make sure that the quality and presentation of the food was improved. Monitoring was put in place to make sure the quality of the food served to people living at Bishop’s Court was of a good standard. We have received no complaints about Bishop’s Court since our last visit to the home in July 08. There has been a safeguarding referral about medication management and one of our pharmacists visited the home to check on the management of medicines there. We found that that people were being placed at risk through poor medication management and we made requirements for the shortfalls identified to be put right. At this visit, we found that this had been done. Social workers involved with people who live at Bishop’s Court told us that they had seen improvements there during a recent visit they made to the home. Previously, they told us they had noted shortfalls in care planning, wound dressings, medicine management and lack of end of life planning. This had been brought to the attention of the management for action to be taken to improve these shortfalls. Bishop`s Court DS0000059340.V369800.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 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. Improvements have been made so the home is well maintained to make sure that people live in comfortable, clean and safe surroundings that suit their needs. EVIDENCE: During our visit we walked round the home to see the shared areas, the bathrooms and some bedrooms. At previous visits, we found that some of the bathrooms had been used for storage. At this visit, we saw that all the bathrooms were available for people who live in the home to use. The shower room has had new non-slip flooring fitted to avoid accidents, and the extractor fan has been repaired. The shower has good access for people who use wheelchairs. Bishop`s Court DS0000059340.V369800.R01.S.doc Version 5.2 Page 21 A variety of aids are available throughout the home to help people who are frail to maintain their independence as much as possible. This included electric beds, pressure mattresses, call system, pressure mats, bath chairs and hoists. There are also aids to orientation, such as pictures and sign posting, to help people who may be forgetful to find their way round the home independently. The corridors have been decorated since our last visit. The refurbishment programme for the home is nearly finished, with three bedrooms remaining to be decorated. The lounges and dining room look clean and bright and have new furniture and curtains. There are plans to place occasional tables in the lounges, for convenience and to make the rooms look more homely. We visited four bedrooms, which were in good condition with clean bedding and good stocks of continence pads. There was also a well- stocked central store of continence pads and a linen store, with good stocks of spare bedding and towels so that people living in the home would not go short of these items. We checked bedrails and saw bumpers in place. These fit beneath the mattress and cover any gaps so that people cannot become trapped in the rails. The bedrails in use in the home are checked every day by designated staff and information on their safe use is displayed in bedrooms. There is now an in-house laundry, which means that items for laundering are no longer washed in the laundry shared by three homes on the site. The previous arrangement had resulted in items being mislaid and residents and their families made a number of complaints about this. The new laundry has an industrial washer and dryer and designated laundry staff are employed. A member of staff said, the new laundry is “brilliant,” and that people now have enough clean stock of their own clothes. All areas of the home we visited were clean and tidy. There was a slight odour in hallway on our arrival but this cleared through the day. Bishop`s Court DS0000059340.V369800.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. There have been improvements in staff attitude, skills and motivation since the last visit but more improvements are needed to show that staff have received training and thorough vetting has been done on them to make sure they are suitable to work with the people who live at Bishop’s Court. EVIDENCE: Bishop’s Court has a staff roster that shows the names of staff on duty for each shift. To make sure that people are properly supported, there are two trained nurses on duty in Bishop’s Court throughout the day and night, and at least five care assistants. There are support staff, such as domestic, laundry and cooking staff, an administrator, handy person and activities co-ordinator to provide support for the nursing and care staff. Records we saw showed that before new staff start work at Bishop’s Court a series of checks are carried out on them. These include obtaining written references and a Criminal Records Bureau check (CRB). The administrator has audited staff files to ensure that these checks have been carried out on all staff. Where the information is not available they have taken action to obtain it. However no action plan is currently in place to ensure all information is obtained. As these checks help to ensure staff are suitable to work with people Bishop`s Court DS0000059340.V369800.R01.S.doc Version 5.2 Page 23 who may be vulnerable, an action plan with clear dates would help the home to ensure they receive the required information in a timely manner. Similarly a training chart has been drawn up for staff that lists the basic training they should all have. Where evidence of training undertaken is not available they are taking action to obtain it. Records and discussion with staff show that a number of training events have taken place recently, both in basic areas of care such as moving and handling of people as well as more specialist areas such as supporting people who have dementia. A member of staff told us that they have “been on many courses” recently and they feel these have helped to improve the support they provide. They explained that staff are clear about their role. This was evident in our discussions with staff. They were able to explain how their role fitted into the overall running of the home, and were clear about how they communicate information about the support needs of the people living there. This helps to ensure that people receive a consistent service and that their needs and choices are identified and met. No overall plan for staff training or record of training received by individual staff is available. For example, some staff recently received training in tissue viability but we did not seen records to confirm this. An overall training plan and record would help to identify more specialist training undertaken to make sure that the individual needs of the people living there and ensure plans are in place to deliver this. In discussion with staff, we noted that they are motivated to support people well and to improve the service they provide. Staff told us that they like the staff meetings they have as, “Now we know what is going on” and the meetings provide a way to discuss, “How to go forward”. This involvement of all staff in planning how to improve the quality of care provided is good practice as it helps to motivate them and inform them about their role to make sure they provide good quality care for the people who live in the home. Bishop`s Court DS0000059340.V369800.R01.S.doc Version 5.2 Page 24 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. Consistency in management of Bishop’s Court recently has meant that some outcomes for residents have improved. More work is needed to ensure people’s views about the home are obtained and they will be protected through more openness from the organisation about how their money is managed. EVIDENCE: A number of managers who were appointed, have left Bishop’s Court over recent months and the general manager has been overseeing the home until a permanent manager is in post. This has meant there has been more consistency in management of the home. Some standards in Bishop’s Court that we previously rated as poor have been rated as adequate following this Bishop`s Court DS0000059340.V369800.R01.S.doc Version 5.2 Page 25 visit. More work is in progress and further work will be needed, to raise standards further to improve the quality of outcomes for the people who live at Bishop’s Court. A manager for the home has been appointed recently and will be applying to us for registration. The general manager will remain in his support role for a few months to help the new manager settle in and continue the improvements being made in the way the home is run. Staff we spoke with told us that they are confident in the management team working at Bishop’s Court. They said that they receive support and advice when needed and are guided in how to support people well. Regular audits, including staff files, medication management and training are now carried out at the home. These help to check the quality of the service being provided. They also help the manager to quickly note and deal with any issues that may arise. Plans are in place to start a family committee in the home. This will provide people’s relatives with a forum to raise any issues they may have as well as provide a way for them to help plan and be involved with improvements to the service provided. The views of the people living there have not been formally obtained recently. A questionnaire was available to help gain people’s opinions about the home. However this was seventeen pages long, covered ten subjects and was in small print. In addition it was not all written in plain English and did not use photos or pictures that could help people understand as much as possible. This survey does not meet good practice guidance for working with people who have dementia and may not be the best way to obtain their views in a way that can make a real difference to making sure their home is run in their best interests. Bishop’s Court provides safe storage for people’s money and records are kept of any transactions made on their behalf. We checked some of these against the money held and receipts of purchases and found them to be accurate. Currently one member of staff signs for transactions and also audits the money each week. In order to ensure peoples money is managed as safely as possible it would be good practice to obtain two signatures on monies spent, as well as having a second person involved with the audits from time to time. The organisation acts as appointee for many people’s benefit money. This is initially paid into an organisation account. Once fees are paid, the money belonging to the person is transferred to a ‘residents’ bank account. This helps to ensure people’s money is as safe as possible. However there were no clear records available as to why the organisation acts as appointee for people and how the decision for it to do so was reached. Similarly no clear explanation was on file in the home to explain how the company manages people’s money. It would benefit the people living there and their representatives if a simple explanation of exactly how their money is Bishop`s Court DS0000059340.V369800.R01.S.doc Version 5.2 Page 26 managed was available. An assessment for each person affected should also be carried out to show why the company is acting as their appointee and how this decision was reached. Records and certificates in the home showed that regular checks are carried out on the environment and equipment to ensure that Bishop’s Court is a safe place for people to live and work. Bishop`s Court DS0000059340.V369800.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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X 3 3 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 2 X X 3 Bishop`s Court DS0000059340.V369800.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 When writing care plans staff should make sure that the each plan sets out in detail the action which needs to be taken by staff to ensure that all aspects of the health, personal and social care needs of the service user are met. 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 for action 24/11/08 2 OP9 13(2) 24/11/08 3 OP35 20 (3) A financial assessment should be 24/11/08 carried out for everyone living at or who moves into Bishop’s Court for whom the organisation acts as appointee for their benefits. This will help to ensure that the organisation do not act as appointee for people unless no alternative is available. Bishop`s Court DS0000059340.V369800.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 OP7 Good Practice Recommendations 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 wound care and swallowing difficulties) are written in their care plans. 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. Nurses at the home should have sight of prescriptions before they are dispensed so that any unexpected changes can be queried before medicines arrive at the home. The procedures for managing medicines at month-end should be reviewed to ensure they would identify where changes have been made that need to be carried forward to the next month. More outings into the local community should be 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. 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. Consideration should be given to providing simple ingredients to make a hot meal in the service room. A ‘snack box’ would provide people with the choice of having a hot snack at times other than designated meals times, if DS0000059340.V369800.R01.S.doc Version 5.2 Page 30 2 OP8 3 OP9 4 OP9 5 OP12 6 OP15 7 OP15 Bishop`s Court they wished. 8 OP29 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. An overall 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. 10 OP31 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. Wherever possible two people should sign for any money spent on behalf of one of the people living at Bishops Court. Different staff should undertake the weekly audit of people’s money held within the home. A easy to understand explanation of how the organisation manages people’s money should be made available to everyone living at Bishop’s Court and their representatives. This will help to quickly note any issues that may arise and to ensure people money is managed safely. 9 OP30 11 OP33 12 OP35 Bishop`s Court DS0000059340.V369800.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North West Region CSCI Preston 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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