Inspection on 02/01/07 for Bishopsmead Lodge

This inspection was carried out on 2nd January 2007.

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

Bishopsmead Lodge 22/01/08

Bishopsmead Lodge 12/07/07

Bishopsmead Lodge 27/06/06

Bishopsmead Lodge 28/02/06

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bishopsmead Lodge Vicarage Road Bishopsworth Bristol BS13 8ES Lead Inspector Vanessa Carter Key Unannounced Inspection 2nd and 3rd January 2007 09:30 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 Bishopsmead Lodge DS0000066339.V324132.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. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bishopsmead Lodge Address Vicarage Road Bishopsworth Bristol BS13 8ES 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) 0117 935 9414 0117 935 9424 None Mimosa Healthcare (No4) Limited Marcia Dawkins Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51) of places Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The Registered Manager must be a RN1 or RNA on the NMC register May accommodate 4 persons aged 51 years or over who have a physical disability and require nursing and personal care 27th June 2006 Date of last inspection Brief Description of the Service: Bishopsmead Lodge Nursing Home is a purpose built care home, designed to accommodate up to 51 persons over the age of 65 years. The home is a twostorey building with lift access to the first floor. There are 43 bedrooms for single occupancy and four shared rooms. All rooms have ensuite facilities including a toilet and wash hand basin. The home is owned and run by Mimosa Healthcare Ltd, a Nottingham based company that expanded into the West Country in 2006. Along with Bishopsmead Lodge, there are three other care homes in the Bristol area Honeymead Care Home in Bedminster, Sunnymead Manor in Southmead and Kingsmead Lodge in Shirehampton. This home is located in the residential area of Bishopsworth on the south side of Bristol close to local shops and the library. Car parking is provided to the front of the property, and to the rear is a small paved area where the residents can sit outside in the warmer weather. Fees for placement at the home currently range from between £348 - £550, and are determined on an individual basis. Hairdressing, newspapers and chiropody costs incur additional charges. Prospective residents can be provided with information about the home (Service Users Guide) and this will detail the services and facilities available at the home. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over two day. At the previous inspection in June 2006, the home was found to have major shortfalls in a number of areas, and had been classed as a service of concern. This follow up inspection is to check on the progress the home has made in meeting the requirements and in complying with the Care Standards Act 2000. Evidence was gathered from a number of different sources: - Information taken from the pre-inspection questionnaire - Information supplied by Bristol City Council and PCT colleagues - Directly speaking with residents and some visitors during the visit - Case tracking a number of residents - Speaking with the acting home manager - Speaking with care and ancillary staff - Speaking with registered nurses - A tour of the premises - Examination of some of the homes records - Observations of staff practices and interaction with the residents. The home is currently without a registered manager and an acting manager is temporarily running the home. The acting manager was present during the inspection. The home is not running to full capacity and during the inspection had only 38 residents – 28 nursing residents and 10 residents who only need personal care support. The overall analysis is that the home is a poor place in which to live and work, and remains classed as a service of concern. Four regulation 43 enforcement notices have been issued to Mimosa Healthcare. What the service does well: Written information, that is available about the home, and the admission processes ensure that placement is only offered to those whose care needs can be met. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 6 Residents can choose to participate in a wide range of activities, and have access to a daily “club” where they can choose what they would like to do. The residents are well fed and have a choice of a wide variety of different meals. Residents live in a comfortable, well maintained, clean and tidy home which is free from any unpleasant odours. The home is well equipped. What has improved since the last inspection? What they could do better: The home must improve the way in which healthcare monitoring is undertaken and the records that the staff keep during this process. Some improvements are required in the homes medication systems. The home must improve the way in which complaints are handled and ensure that they follow their complaints procedure. This will ensure that residents and their relatives feel that any concerns they have are listened to and acted upon. Improvements are required in staff awareness of the procedures to follow, should adult protection issues be raised. The staff team needs to be improved by having administrative support, a deputy and appointing a new registered manager. This will enable the home to be run better and the residents to improve a better service. The home needs to look at the training and development needs of the staff team and formulate a training plan. This will ensure that the staff have the collective skills to meet the residents needs and do so safely, following safe working practices. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 7 To ensure that the home is run in the resident’s best interests, the home must have quality assurance systems so that they can review and improve the quality of the service. The home must ensure that staff follow safe working practices at all times and are fully aware of the actions they should take in the event of a fire. The home must identify any unnecessary risks to the health & safety of residents by taking actions to eliminate them. Monitoring of any falls will enable the home to identify any trends or patterns. 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. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 8 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 Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 9 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, 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Written information, that is available about the home, and the admission processes ensure that placement is only offered to those whose care needs can be met, but new residents must be provided with a written contract. EVIDENCE: The home’s Statement of Purpose and Service Users Guide, (Welcome Pack) accurately reflects the current service provision, and contains all the necessary information to enable any prospective resident to make an informed decision about moving to the home. Copies of this document were present in most rooms. Only one of the seven CSCI survey forms was completed and returned – the resident said that they had been provided with information about the home prior to moving in, enabling them to make a decision that the home was the right place for them. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 10 For the most recently admitted residents, there was no evidence that they had been provided with a copy of the terms and conditions of residency. For one other person who had initially been funded by the local authority, but had become a privately funded resident, there was no evidence that they had been provided with a new contract. Each resident, or their representative, must be provided with a statement of terms and conditions at the point of moving in to the home. The home is currently without an administrator but must have systems in place to ensure that residents, relatives or representatives, receive and return this document. The home’s admission procedure states that prospective residents will have been fully assessed prior to being offered placement. This will ensure that the home is suitable for the purpose of meeting their needs. Two pre-admission assessments were looked at – both contained a comprehensive picture of the resident and their care needs, were signed or dated therefore verifying that they were completed prior to admission. Information is gathered from social workers and other healthcare professionals where appropriate. Upon admission, the home complete a further ‘Physical and Social Assessment’. This is only a “tick box” and is used to follow through into the care planning documentation. The document does not allow the staff to record any specific information about the resident, and should be reviewed. Where possible, prospective residents or their representatives are encouraged to visit the home prior to making a decision about living in the home. They would be shown around, told what the home has to deliver, and given an explanation of how their needs are going to be met. The majority of residents are admitted in to the home following a hospital admission however short stay admissions are sometimes used to introduce people to care home life. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 11 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s care planning processes are now better but improvements must be made with healthcare monitoring and some of the medication systems, to ensure that residents receive the medical care they need and are safeguarded from mistakes being made. EVIDENCE: Four care plans were looked at, two from each floor. Following the last inspection in June, the home was issued with an enforcement notice in respect of their poor care planning processes. Significant improvements have been made, with one identified member of staff evidencing their skills in writing person centred plans. The plans covered a range of specific needs for each resident, and they contained information about the person’s social and family history. The plans followed on from the information contained on preadmission assessment documentation. Minor improvements on each of the plans were discussed with the acting manager at the end of the inspection. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 12 Whilst the care planning was good, the procedures in place for monitoring health care needs were poor. A number of residents with low body weight, who had identified nutritional needs in their care plans, were not having their dietary intake adequately monitored. Staff were recording “breakfast/lunch/ tea given” with no indication how much was eaten. One resident who was being given supplement drinks, had two full opened cartons sat in front of them, but was unable to manage to lift the cartons. All residents are weighed on a monthly basis irrespective of whether this would be more appropriate if done more often. One resident had a recorded weight loss of 5kg in a month whilst another had a phenomenal weight loss recorded (15kg within one month) – for both residents there was no evidence that this had been reported to the GP for further advice. Wound care planning documentation was good and contained clear instructions for staff to follow about how often dressings were needed and what products should be used. However, the staff were not making a record when dressing were done or how the wound was progressing. One GP had commented on a CSCI survey form that “ recent changes have shown some improvements in communication and care but there is some way to go”. These shortfalls have the potential to place the residents at risk of not having their physical and health care needs met appropriately. A social worker reported their concerns to CSCI in November that the home had still not registered a new resident with a GP two weeks after placement, and this matter had only been resolved by their actions. This is not good enough and does not evidence that the home enables residents to have access to healthcare services. The CSCI pharmacy inspector visited the home on 14th December 2006, as part of this key inspection. The morning medication round was observed and the arrangements for storage, receipt, and disposal of medicines, were examined. The home must ensure that medications are always stored safely and within safe temperatures. Measures must be taken to ensure that oxygen cylinders are secure and cannot fall over and cause injury. The warning sign outside the room needs to be updated to include warnings not to smoke and avoid naked flames. Management of Controlled Drugs would be safer if two nurses signed the disposal record. Most medication is supplied in monthly blister packs. These packs indicated that medicines had been administered as recorded on the medicines administration record (MAR) sheet. Auditing of other medications was difficult because it was not clear when a pack had been started or how much medication a new resident had brought into the home. The pharmacy provides printed MAR sheets for staff to record medications received into the home and also medications administered to residents. Where residents refuse medications, a record must be kept of the disposal of that medication. The timescale for compliance was discussed with the registered nurse at the time of the pharmacy inspection. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 13 During the inspection visit in January, the medication round on the ground floor was observed to take a considerable length of time. This means that some residents are not receiving their morning medications at the prescribed time. This was discussed with the manager and must be addressed. The staff were observed going about their duties in a friendly and calm manner, and responding to the residents with a familiar style. There was friendly banter between the residents and the staff, and one resident said, “I like to have a laugh and joke with the girls”. One resident said that the staff were always kind and that assistance with personal care tasks is given in privacy. Care staff were observed knocking on doors before entering a room and speaking to residents respectfully. However, the practice of displaying resident’s charts outside their rooms, for everyone to see is, is not acceptable. For one resident a list of “incidents of challenging behaviour” was easily readable by all who passed by. This is not acceptable and does not respect the resident’s dignity. The practice was discussed with the manager, with a request that an alternative be found. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 14 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can choose to participate in a wide range of activities and are well fed. EVIDENCE: The home employs an Activities Organiser for 25 hours per week, who works between the hours of 9.30 – 3pm each weekday. There is a weekly plan of activities, however this is often guided by what the residents want to do. The small lounge upstairs is used as a “club” room, and group activities happen in the morning, with one-to-one work in the afternoons. Residents said they were “off to club” and the manager explained that a group of residents had decided to refer to the room as the club rather than the activities room. Residents are able to choose whether to participate or not and a record of each resident’s involvement in the activities is maintained. Only one CSCI resident survey form was returned and the resident stated, “there were always activities arranged by the home that you can take part in”. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 15 The home was currently decorated with Christmas trimmings and artwork made by some of the residents was displayed on the walls. Some external entertainers are arranged to visit the home and provide music sessions. One resident said she liked the sing-a-long sessions, others said that they preferred to stay quietly in their own rooms. The home has an open visiting policy and visitors are asked to sign in at the front door, to comply with fire regulations. Three relative comment cards were returned to CSCI – all three stated said they could visit their relative in private, and that they were kept informed of any important matters. A number visited the home during the inspection and staff were friendly and welcoming towards them. Two relatives spoken to during the inspection said that they enjoyed visiting the home, and there had been a good atmosphere over the Christmas period. The local school had called to the home prior to Christmas and the children had sung carols for the residents. Residents are able to choose where they would like to spend their day and where they take their meals. Whilst it is inevitable that the home has routines to follow, there was evidence that residents can have a say what time they like to get up and retire to bed at night. Staff made reference to those residents who prefer to get up early or later on in the morning. The home has a four-week menu plan and this was provided during the inspection. Some times the planned meal has to change because of difficulties with the food order. There is a choice of two main midday meals and on day one of the inspection, braised steak or pork chops was on offer. These meals were served along with vegetables, and followed by fruit and custard. One resident said she was always given too much to eat, and she didn’t like wasting the food. One other resident said, “the midday meal is sometimes served late, but generally the meals are good”. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 16 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Improvements must be made with the way that complaints are managed and with staff awareness of safeguarding adult issues, to ensure that any complaints are dealt with appropriately and residents are protected from any harm. EVIDENCE: The home’s complaints procedure is displayed in the main foyer and also included in the home’s statement of purpose and welcome pack, provided to each resident and their family. One relative said that they would see the manager if they had anything to complain about, whilst another said that concerns that they had had in the past, had been promptly dealt with. Two of the three relative survey forms returned to CSCI stated that they were aware of the homes complaints procedure. CSCI have not received any complaints directly; however, they have been copied into correspondence from the local authority to the home, regarding three separate outstanding complaints that have not been resolved. None of these complaints were recorded in the homes complaints log. This is poor practice and does not evidence that the home take complaints seriously. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 17 Residents spoken with during the course of the inspection said that they would ask to see the manager if they had any complaints. One resident said, “ it didn’t do any good to grumble, everyone does the best they can”. Another said, “I can speak up for myself, but I do worry for those who can’t”. The home must improve their management of complaints to ensure residents and their families, that any concerns they have will be listened to, taken seriously and acted upon. The home has a Protection of Vulnerable Adults (POVA) policy. Staff spoke to during the course of the inspection showed good basic awareness of adult protection issues and of the responsibility they have towards safe guarding the residents from harm. Some staff were not aware whether the home had a ‘whistle blowing policy’. All staff would report concerns to the manager and had expectations that she would take the necessary actions (involve the other agencies). Some staff have attended POVA training, whilst others said they had not. The home currently uses an internal trainer for adult abuse training, plus a distance learning pack. The home should consider using the local authority training that is run by the Safeguarding Adults Coordinator, to ensure that they have are aware of local protocols and procedures. The home does not have up to date records in respects of training therefore it was difficult to determine what percentage of staff have received recent training. This aspect will be referred to again later in the report. This shortfall does have the potential to mean residents may be cared for by staff who will not protect them from harm. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 18 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, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable, well maintained, clean and tidy home which is free from any unpleasant odours. EVIDENCE: The home is a purpose built two-storey building, with lift access from the ground to first floor. Car parking is available to the front of the building, and although there is an incline of the path up to the front door, there is level access into the home. The front entrance is secured with a key padded system, so the home is safe and protected. To the rear of the home there is a very small paved area, and the downstairs lounge opens out on to this area. This area is used by those who like to have a cigarette – a covered area has been provided. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 19 The home meets all the standards required and has sufficient communal areas (lounges and dining rooms), bathrooms and toilets, to meet the needs of 51 residents. Currently the home has only 38 residents, spread between the two floors. Since the last inspection a bathroom on the ground floor has been converted into a level access shower room and one on the first floor has been changed into a hair saloon. There are now three bathrooms per floor, but one is “temporarily out of order”. When the home has 51 residents it must have a minimum of six serviceable bathrooms. The home is well decorated throughout. Rooms are redecorated in between residents where required. The majority of bedrooms were seen during the inspection, were each comfortable furnished and had been personalised to reflect personal taste. The home has an adequate supply of equipment to assist the care staff with moving and transferring residents with impaired mobility. The equipment was last serviced in February 2006, and the recommendations are that this should be serviced on a six monthly basis. Other items of disability equipment were located throughout the home to aid the residents and care staff in meeting personal care needs. A number of specialist nursing beds have already been purchased. Each bedroom had en suite facilities of a toilet and wash hand basin. There are four shared rooms each with privacy screening in place. Two single occupants currently reside in two of the shared rooms. Residents are encouraged to bring in as much of their own furniture and belongings as they wish – the home will make an inventory of each resident’s personal belongings. The home is centrally heated and well lit with domestic style light fittings. Each bedroom has an opening window, fitted with width restrictors for safety. Emergency lighting is installed throughout the home and this is checked on a regular basis. The home was clean, tidy and free from any offensive smells. The housekeeping staff were observed working diligently during the inspection, and interacting with the care staff and the residents. One resident said they liked “the young girl who cleans my room and has a chat with me”. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 20 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Improvements must be made in meeting the training needs of staff to ensure that the residents are cared for by staff who are competent and have the necessary skills to care for them. EVIDENCE: The home has a number of staff vacancies at the moment and the manager is interviewing for an administrator, laundry staff and night care staff. Recruitment is also ongoing in preparation for the home having full occupation. A team of housekeeping, laundry, maintenance and catering staff support the registered nurses and care staff in meeting the resident’s daily living needs. On both days of the inspection there was one registered nurse plus either one senior carer and three carers or four carers, on each floor. Two relatives stated on the CSCI survey forms that “in their opinion there were always sufficient staff on duty” whilst a third did not agree with this. The home currently has only 28 nursing residents and 10 ‘personal care’ residents, and these levels of staff are appropriate. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 21 Whilst the home has few staff vacancies, the absence of an administrator means that some of the homes systems and records are disorganised. The home has previously benefited from a deputy or a lead nurse, but is currently without such a person. In view of the difficulties this home is having, a “deputy” should be employed to provide support to the manager and additional support for the care staff and registered nurses. The home has only five members of care staff (out of 24) who have achieved the NVQ level 2 in care (21 ), but four others are working towards the award. One of these four said they were hoping to have completed the course by the beginning of the summer (37 ). There will be a further cohort of staff who will start the training after this. It is an expectation that all new staff recruited to work at the home will start the NVQ Level 2 after a period of time. The home must continue to work towards achieving a 50 ratio of trained members of care staff. This will ensure that residents are cared for by staff who are skilled and competent. The staff files of nine recently recruited staff members, plus three others were examined. POVAfirst checks had been obtained on all the new staff prior to their start date, and had been followed up with CRB disclosures. At the last inspection in June 2006, three staff had started working in the home before the full checks had been completed – their documentation was now complete. A number of the files of new staff members did not have two written references, but the manager was adamant that staff are no longer employed without safe vetting procedures being followed, and felt this was due to the homes poor administrative systems. New staff members have an induction programme to follow when they start employment. One such programme was seen and the employee said that the process had enabled her to settle in to the home and find about work practices and procedures. A registered nurse said that they had been well supported when they started at the home. The only training matrix that was available was out-of-date; therefore the manager was unable to provide an overview of what training each staff member had received. The upkeep of staff training files and training logs has fallen by the wayside. At the last inspection in June 2006, the home were aware that the majority of staff need to receive training in all mandatory subjects - food hygiene, health & safety, POVA, fire, first aid and basic life support. There was no evidence to suggest that any progress has been made in addressing this shortfall. One staff member said they had recently done an infection control course, but had not received a certificate. Another staff member said they’d had continence training. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 22 Most of the staff spoken to during the inspection, said that they were due for manual handling refresher training. There are no systems in place to ensure that staff receive refresher training when appropriate. There were no records of when staff had received fire training. Some said that they had had training since June and had also completed a distance learning pack – these were found during the inspection but had not been processed. The opportunities for staff to participate in fire practice sessions are inadequate and do not encompass the whole team. This will be referred to again under the health & safety section. In order for the home to gain an overview of the skills and competencies of the staff team, plus identify any training and development needs, they should complete an ‘appraisal’ with each staff member. The home will then be in a position to be able to formulate a training plan. This process can be linked into staff supervision arrangements that have also fallen by the wayside. Bishopsmead Lodge DS0000066339.V324132.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): 31, 32, 33, 35, 36 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Improvements must be made in the management of the home to ensure that residents live in a home that is safe and run in their best interests. EVIDENCE: The home is currently without a registered manager or a deputy, and an ‘acting manager’ has been in post since the middle of October 2006. This is her first home manager post, having previously worked within the NHS. Whilst the acting manager has the necessary skills and qualifications to be the registered manager, there is so far no decision for her to make application to the CSCI to be the registered manager. The home has had a further year of instability and requires a stable management structure in order to raise standards and comply with the Care Standards Act. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 24 The acting manager has not had any relatives meetings and there has only been the one staff meeting when she first started. Both will be reintroduced as a matter of priority and will be used to capture the views of residents, relatives and of the staff team. The home has been under the ownership of Mimosa Healthcare for one year but so far a ‘customer satisfaction survey’ has not been completed. The acting manager advised that this will be undertaken in the next few weeks, the paperwork has already been printed. A copy of the results from this survey should be forwarded to CSCI, together with an annual development plan for the home. A senior person from Mimosa visits the home on a regular basis, at least once a month, but needs to ensure that these visits are more robust and addresses the shortfalls, highlighted throughout this report. The home looks after monies for some of the residents and maintains good administration systems of all transactions to and from the accounts. Three sample accounts were checked and each tallied. Staff said that they do not have supervision with a senior member of staff or the acting manager, but they are able to have informal support at any given time. The acting manager confirmed that a programme of staff supervision had not been established yet. Care staff said that on some shifts, the registered nurse does not provide any support with the ‘hands on care’. One staff member said that there is a lack of consistency in how each shift is run therefore “teams work against each other”. The care staff were observed working very hard but the culture is that they make decision themselves which may not be in the residents best interest. This is not good practice and has the potential to place the residents at risk from receiving an unsafe service. The home is well maintained, and in good decorative order. Gas, electrical and central heating systems had each been serviced within the last year. Hoisting equipment was last serviced in February 2006 and the passenger lift in November 2006. Housekeeping staff had access to the COSHH sheets for all the cleaning products they use. The home does not ensure that all staff use safe working practices, therefore staff may not have the necessary skills to safely care for the residents. Most staff spoken to during the inspection said that they were due refresher training in safe moving and handling techniques – there are no systems in place to check when staff have received instruction and when their refresher training is due. Observations made during the inspection were that staff do not always follow safe procedures for moving residents from one place to another. One specific example was discussed with the members of staff and the acting manager at the end of the inspection. Other agencies have reported to CSCI that they have witnessed unsafe manual handling, whilst visiting the home. Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 25 Manual Handling risk assessments do not result in a safe system of work being devised. The home must develop a ‘stand alone’ assessment of each resident’s manual handling needs, to ensure that they are always moved correctly, using the right equipment, and are safeguarded from injury. The records concerning fire safety checks are complete. However, all day and night staff are not participating in regular fire practice sessions to ensure that they would be able to act appropriately should a fire occur. Discussions with some staff evidenced that there was some confusion about the homes actual fire procedures. The fire officer states that night staff should take part in fire practices every three months and day staff every six months. The fire log contained some details about when the fire alarm had been activated by “burnt toast” for example, but these always happened around breakfast time but some were undated. By the end of the inspection, the home had set up three fire training sessions and had arranged a fire drill with the night staff. For this reason an immediate requirement notice was not issued, but a requirement will be made that staff are kept fully trained in fire safety procedures. The home completes an accident form when a resident has a fall or other such incident however does not record any ‘follow up’ action or keep a log for each resident, or an overall picture of accidents in the home. This would enable any trends to be identified and preventative actions to be taken. Bishopsmead Lodge DS0000066339.V324132.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 3 1 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 3 1 X 1 Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 5 Requirement All new residents to be provided with a written contract for the provision of services and facilities. Signed copies to be available for inspection. The home must promote and make proper provision for the health and welfare of service users. • The records made to assist in monitoring residents health care needs should be accurately kept and clearly evidence the care given. Timescale for action 03/02/07 2. OP8 12(1)a 08/03/07 (the previous timescale of 27th July 2006 has not been met and an enforcement notice has been issued). 3. OP9 13(2) The home must have safe 03/02/07 procedures in place for the recording, handling, safekeeping, safe administration and disposal of medications received into the home. • Medications must be administered at the times instructed by the GP DS0000066339.V324132.R01.S.doc Version 5.2 Page 28 Bishopsmead Lodge • • • • Oxygen cylinders must be securely stored. Statutory warning signs must be displayed when oxygen is stored Records must be kept of all medicines received into the home and of those sent for disposal. These must be double signed. Medications must be administered at the time prescribed by the GP. 03/02/07 4. OP16 22 The home must ensure that any complaints made about their service is handled as per their Complaints Procedure and are fully investigated • Complainants must be informed within 28 days what action the home will be taking. • A log should be maintained of all complaints, so that information can be supplied to the Commission The home must employ suitably qualified and competent persons to provide effective management and administrative support, so that the home is well run. All staff must receive training appropriate to the work they are to perform • Complete an appraisal of each staff member to identify training and development needs • Provide a training plan for the home, evidencing how the training needs will be met. 5. OP27 18(1)a 03/04/07 6. OP30 18(1)c 04/04/07 Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 29 • Maintain a training log for each staff member and a home training matrix to identify when refresher training is needed. 03/03/07 7. OP31 8(1)a A home manager must be appointed who subsequently makes application to the Commission for registration. The home must establish and maintain a system of reviewing and improving the quality of care. • Quality Assurance systems must be in place to ensure that the home is run in the best interests of the residents. “Reg 26” visits must be more robust. • A copy of the results from the survey should be forwarded to CSCI along with the homes development plan. 8. OP33 24 27/04/07 (the previous timescale of 27th December 2006 has not been met and an enforcement notice has been issued). 9. OP36 18(2) (the previous timescale of 27th August 2006 has not been met and an enforcement notice has been issued). All staff who work at the home 04/04/07 must be appropriately supervised. • Staff must be appropriately supervised and their work monitored, on a day-today basis and also a formal basis. 10. OP38 13(5) The home must make suitable arrangements to provide a safe system for moving and handling residents. 16/02/07 Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 30 • • • Staff must be fully trained in Manual Handling techniques and receive regular refresher training. A safe system of moving and handling must be devised for each resident, where appropriate. Staff must always follow the agreed safe systems of moving and handling. (the previous timescales of 27th July and August 2006 has not been met and an enforcement notice has been issued). 11. OP38 23(4)d,e (the previous timescale of 27th June 2006 has not been met). Arrangements must be made for persons working at the care home to receive suitable training in fire prevention and be aware of the homes fire procedure. • All staff must participate in regular fire practice sessions, night staff 3 monthly and day staff 6 monthly. Accurate records must be maintained and available for inspection. 19/02/07 12. OP38 13(4)c The home must identify any 03/02/07 unnecessary risks to the health & safety of residents and take the appropriate actions to eliminate them. • All accidents and any follow up action should be recorded. • A record of all accidents should be maintained for each resident, to enable any trends to be identified Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 31 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. 2. 3. 4. 5. Refer to Standard OP3 OP9 OP10 OP18 OP18 Good Practice Recommendations The provider should consider reviewing the ‘physical and social assessment’ form, to ensure it captures a full assessment of needs. The home must ensure that are able to audit all medicines supplied in a standard pack. The home should take care with details about residents and not display information that can be read by others. The home must make sure that each staff member is aware of the company’s whistle blowing policy The home should consider attending the local authority POVA training sessions, so that staff are fully aware of the protocols to follow should abuse be witnessed or suspected. The home should continue to work towards achieving a 50 ratio of trained members of care staff. The home should hold regular resident and/or relative meetings, in order to capture their views and have a say in how the service is delivered. The home should hold regular staff meetings to ensure that the team work consistently, and that the homes performance can be openly discussed. All staff should receive supervision at least six times per year and records should be kept. 6. 7. 8. 9. OP28 OP32 OP32 OP36 Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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. Extracts may not be used or reproduced without the express permission of CSCI Bishopsmead Lodge DS0000066339.V324132.R01.S.doc Version 5.2 Page 33 - 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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