CARE HOMES FOR OLDER PEOPLE
Bishops Court Care Home Tuxford Road Boughton Newark Nottinghamshire NG22 9HY Lead Inspector
Richard Ramsden Key Unannounced Inspection 19th October 2006 9:30 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 Bishops Court Care Home DS0000035672.V302746.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. Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Bishops Court Care Home Address Tuxford Road Boughton Newark Nottinghamshire NG22 9HY 01623 862043 01623 836070 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) Nottinghamshire County Council Mrs Virginia Bullock Care Home 45 Category(ies) of Dementia (19), Dementia - over 65 years of age registration, with number (19), Old age, not falling within any other of places category (45), Physical disability (5) Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Out of the total number of beds (45), there will be 19 beds for DE 55 and over and/or DE(E) Out of the total number of beds (45), 5 may be used for PD 55 and over Service users shall be within category OP(45) Date of last inspection 27th October 2005 Brief Description of the Service: Bishops Court is a Care Home providing personal care for 45 older people of both sexes, in single rooms with hand washing facilities. It is owned and managed by Nottinghamshire County Council Social Services and is a single storey building, which was purpose, built in the 1980s. It comprises of five units, each having its own lounge, dining room, bathing and toilet facilities as well as a small kitchen for the preparation of snacks. Communal space and lounges are also available throughout the home. There are grounds surrounding the home and a safe enclosed patio garden, which is accessible to all of the residents. Bishops Court is situated with half a mile of the centre of Ollerton, with shops, pubs, library, a doctor’s surgery and leisure facilities. The monthly accommodation charges for those residents who are self funding would be £1508 per calendar month. A copy of the most recent inspection report is available in the home. Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One Inspector completed this unannounced visit over one day it took approximately 7 1/2 hours. It included the inspection of care and other records, a discussion with the registered manager, two members of care staff and the cook. The inspector spoke with four residents and one visitor to the home. A partial tour of the building was also completed. Prior to completing this visit the inspector assessed the homes previous inspection reports, the service history and the Pre-inspection questionnaire, which had been completed by the registered manager. What the service does well:
Staff are ensuring that they to meet the assessed needs of prospective residents prior to their admission to the home. The residents spoken with during the inspection said that the very satisfied with the services provided by the home. They confirm that the staff are always friendly and respectful and that they ensure that the residents privacy and dignity is maintained at all times. One resident said ‘ you couldnt be anywhere better this is a really good place to live.’ The observed interaction between residents and staff was of a very good standard. People confirmed that they can have visitors at any time and stated that their visitors are always made welcome. One visitor said that she visits her husband at least three times a week and that she generally has her lunch, in the home with her husband. Residents stated that the meals are very good and that alternatives will always be provided if people do not want the food suggested on the menu. The cook regularly discusses the meals and menus with the residents. All of the residents stated that they’re very happy with their bedrooms and confirmed that they had been encouraged to personalise them with small items of furniture, photographs, ornaments etc. They confirmed that day can use their bedrooms at any time. The home is purpose-built, it is comfortably furnished and well decorated. The residents and the visitor confirm the home is kept clean at all times. The homes registered manager is well qualified and experienced and ensures that the home is run in the best interests of the residents. The residents and staff said that the manager is a very approachable and that they believe they Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 6 could discuss any issues with her. One resident said that the manager is ‘a really nice person and always has time for everyone’. The staff training records show that a considerable amount of training has been provided since the last inspection. Over 79 of the care staff have completed a National Vocational Qualification. The aspects of health and safety assessed at this visit have all been well maintained and are helping to ensure that residents live in a safe environment. What has improved since the last inspection? What they could do better: 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. Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 7 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 Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3. The literature supplied prospective residents now contains sufficient information for them to make an informed choice as to whether the home will meet there assessed needs. Residents have been provided with written Terms and Conditions of Residence. The homes staff ensure that they can meet the assessed needs of prospective residents by obtaining full written assessments prior to their addmission to the home. Bishops Court does not provide intermediate care. “Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. EVIDENCE: The literature supplied prospective residents been updated and now contains all the required information to enable residents to make an informed choice as to whether the home will meet their needs. This information has been provided in a user-friendly format. (This is good practice).
Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 9 All of the residents’ records viewed as part of this visit showed that Terms and Conditions of Residence documents have been provided and that people were signing to confirm that they had read and agreed with them. Three residents care plans were assessed during this visit and each contained a preadmission assessment, which had been completed by a social worker. The manager stated that residents are always encouraged to visit and spend time in the home prior to their admission. This was confirmed by one of the residents spoken with during the inspection. The home does not provide intermediate care. Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Not all residents’ care plans contain sufficient information to ensure that staff are always aware of what support and assistance each resident requires. Residents’ health care needs are being appropriately met. The homes medication is generally well managed however the records do not show how all of the controlled medication has been disposed of. Residents feel they are treated with respect and their rights to privacy is upheld. “Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. EVIDENCE: Three residents care plans were viewed as part of this inspection, the care plans appeared to address the issues highlighted in the resident’s assessment process. It was noted that all the care plans viewed had been reviewed each month and that the residents had been involved in the planning and review process. However one residents care plan stated that he did not have any ‘skin care’
Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 11 needs. When the resident’s health care records were checked it was noted he had a pressure sore, which the district nurse was treating on a regular basis. There was also a chart requiring staff to apply cream to his legs on a daily basis. It is essential that all care plans are kept accurately updated to ensure that staff are always aware of what support and assistance each resident requires. This care plan was updated during this visit. One resident’s records showed that he had not received a bath or shower for approximately 2 months although his care plan stated that he would like a bath each week. The senior staff stated that they believed the resident had been bathed regularly but that the staff had forgotten to complete the records. When asked the resident confirmed that he had received a bath each week and that he found this to be satisfactory. The residents spoken with during this inspection said that they believe that their health care needs are being appropriately met. The records viewed as part of the visit confirmed this. The homes medication systems are generally well maintained. The manager stated that all staff that administers medication have completed accredited training. The records of receipt and disposal of medication and the administration records were generally well maintained. However the record of controlled medication showed that there should have been 18 tablets in stock, but the home did not have any controlled medication. Records showed, that the resident for whom the controlled medication was prescribed, had been discharged home, however there was no evidence to confirm that she took the medication with her. It is essential that the home keep accurate records of the disposal of all medication .The manager stated that the homes medication policies state that two members of staff should sign to confirm the disposal of all controlled medication. The cupboard in which controlled medication is stored could not be double locked. One member of staff stated that, when the homes medical room was refurbished, staff were informed that a special cupboard had been provided for the storage of controlled medication and that it was no longer necessary to provide a locked container within a locked cupboard. The home could not produce any evidence to support this. The manager confirmed that she would ensure that the cupboard is satisfactory for the storage of controlled medication or have a lockable container fixed into the cupboard. As previously stated the home did not have any controlled medication at the time of inspection. All of the residents and the visitors spoken with during the inspection said that staff are always friendly and respectful and ensure that residents’ privacy and dignity is maintained at all times. Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. The home is providing a range of activities and entertainment, which meets the expectations of the residents spoken with during this inspection. People are encouraged to maintain contact with family and friends. Where possible residents are encouraged to make decisions about their individual lifestyles. All of the people spoken with during the inspection enjoyed the food provided by the home. “Quality in this outcome area is excellent. This judgment has been made using available evidence including a visit to the service.” EVIDENCE: The home is providing a range of activities and entertainment, which meets the expectations of the residents spoken with during this inspection. People are encouraged to maintain contact with family and friends. Where possible residents are encouraged to make decisions about their individual lifestyles. All of the people spoken with during the inspection enjoyed the food provided by the home. Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Residents believe that their complaints would be taken seriously and that appropriate action would be taken. The homes complaints records support this view. The registered person is taking appropriate action to protect residents from abuse. “Quality in this outcome area it is good. This judgment has been made using available evidence including a visit to the service”. EVIDENCE: The home has an appropriate complaints procedure, which is available to residents’ staff and visitors. The homes complaints records show that there have been two complaints since the last inspection, these were dealt with appropriately. The Commission for Social Care Inspection has not received any complaints about home in the last 12 months. All of the residents and the visitor spoken with during the inspection, stated that the manager is a very approachable and that they believed that she would deal appropriately with any complaints or concerns they may have. The inspector was informed that there have been no incidents of abuse, in the home in the last 12 months. The home has a copy of the local Adult Protection Procedures and the manager has a working knowledge of the process. Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 14 The home has an appropriate Whistle blowing procedure and the two members of staff spoken with during the inspection, were clear about their responsibility to report all incidents. There are details of how staff can contact the homes line managers if they wish to report incidents but feel they cannot discuss them with the homes management team. (This is good practice). Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24,26. The accommodation is purpose-built and maintained to a good standard. All residents have now been offered the opportunity to lock their bedroom doors to ensure privacy and the safety of their belongings. At the time of this inspection the home was clean and there were no offensive odours. “Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. EVIDENCE: A partial tour of the premises was completed as part of this visit. The purpose-built accommodation is comfortably furnished and well decorated. All four of the residents spoken with during this inspection said that they liked their bedrooms and confirmed that they could use them at any time. They said that they had been encouraged to personalise their rooms with small items of furniture, photographs and ornaments. The residents confirmed that the home is always kept very clean. Two residents stated that they now have
Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 16 keys to lock their bedroom doors, one person said that they had been offered a Key but that they did not want to lock their bedroom door. The laundry is a good size and well equipped with washable wall and floor coverings. It had been redecorated shortly before this inspection. A new lock had recently been fitted to the laundry door to ensure that residents are not at risk by gaining access to the industrial laundry equipment or the soiled linen. The homes infection control policies were checked and were very well maintained. Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. The staff rotas provided, show that adequate staffing levels are being maintained. The homes recruitment policies and practices are supporting and protecting the residents. The manager was able to demonstrate the homes commitment to staff training and development. “Quality in this outcome area is good. This judgment has been made using available evidence including of visits to the service”. EVIDENCE: The staff rotas provided prior to the inspection and those viewed on the day of inspection, showed that sufficient staff are being provided to comply with previously agreed staffing levels. The manager stated that there were four staff vacancies at the time of this inspection and that there had also been some staff sickness. However adequate cover had been maintained. The residents spoken with confirmed that although the staff always appear busy they still find time for social interaction. The personal records of two members of staff were assessed as part of this visit both sets of records contained all the required information including Criminal Records Bureau Checks, Application Forms and written references. The records show that all staff have completed appropriate induction training. Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 18 Out of a total of 39 care staff 25 have completed NVQ or above and six were completing this training at the time of inspection. (This is good practice). The manager was able to demonstrate that a considerable amount of staff training has been provided on a regular basis. Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. The homes manager is very well qualified and experienced. The home is run in the best interests of the residents. Residents’ financial interests are safeguarded. Where checked the health and safety of residents and staff are promoted and protected. “Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. EVIDENCE: The homes registered manager is extremely well qualified and experienced. Residents and staff said that the manager is very approachable and that she seeks their views about the way in which the home is run. Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 20 Quality monitoring systems are in place, which show that residents and stakeholders in the community are being encouraged to express their views about the services provided by the home. The manager has produced an individual business plan for the home based on the information gathered from the completed quality assurance questionnaires. (This is good practice). The records of residence finances were checked at random and were well maintained. All of the residents who were asked said that they were happy with the way their finances are managed. The records of items handed in for safekeeping were well maintained. All aspects of health and safety, assessed as part of this visit had been satisfactorily maintained. An independent health and safety report produced in 2005 only identified two requirements both of which had been instituted. Regulation 37 The literature supplied prior to this inspection shows that over the last twelve months that 14 Residents had been admitted to Accident & Emergency 1 person had died in the home and 5 people had died in hospital. The homes Service History shows that only one of these serious incidents had been reported to the Commission for Social Care Inspection. It is important that all these incidents are reported as they form part of the Homes review/monitoring process. Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 21 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 X X 3 X X 3 Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 22 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 OP9 Regulation 13(2) Requirement It is required that Registered Person keeps accurate records of the disposal of medication. Two staff must sign to witness the disposal of Controlled Medication in line with the homes Medication Administration Procedures. It is required that the registered person informs the Commission without delay of any incidents as identified in Regulation 37 (1). Timescale for action 19/10/06 2 *RQN 37 19/10/06 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 It is recommended that the registered person ensures that Care Plans are always updated when a residents care needs change, to ensure that staff are always aware of what support & assistance each resident requires. It is recommended that staff accurately record, in each persons care plan, when a resident is assisted to bath. If a resident does not wish to bath this should also be recorded. 2. OP7 Bishops Court Care Home DS0000035672.V302746.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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