Inspection on 11/06/08 for Bluebell Court

This inspection was carried out on 11th June 2008.

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

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

Bluebell Court 16/04/09

Bluebell Court 12/12/08

Bluebell Court 21/06/07

Bluebell Court 14/01/07

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Bluebell Court Stanley Road Grays Thurrock Essex RM17 6QY Lead Inspector Bernadette Little Unannounced Inspection 11th June 2008 09:35 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 DS0000067279.V366253.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. DS0000067279.V366253.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bluebell Court Address Stanley Road Grays Thurrock Essex RM17 6QY 01375 369318 01375 369346 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) Primrose Care Home Limited Suzanne Elizabeth Bennett Care Home 80 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (80), of places Physical disability over 65 years of age (10) DS0000067279.V366253.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st June 2007 Brief Description of the Service: Bluebell Court is a purpose built three storey care home with Nursing for older people who have physical disabilities and dementia and is registered with Commission for Social Care for the continuing care of 80 residents in total. The Home is located centrally in the town of Grays within walking distance of local amenities. The M25, the A13 and Grays railway station are in close proximity. The building has been adapted to provide three purpose built floors, to provide a homely atmosphere for the service users and families. Trained nursing staff and carers are available for the provision of personal and nursing care. Parking is available to the front of the building. The home was registered in July 2006. At the time of the site visit the manager confirmed that the fees ranged from £395.43 to £575.00 per week. DS0000067279.V366253.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 0 stars. This means the people who use this service experience poor quality outcomes. The unannounced site visit was undertaken over an eight and a half hour period by one inspector and a five hour period by a second inspector, as part of the routine key inspection of Bluebell Court. Time was spent with the residents and staff at various times during the day. A tour of the premises was undertaken and records and policies were sampled. The manager submitted an Annual Quality Assurance Assessment (AQAA) as required prior to the site visit. This is required to detail their assessment of what they do well, what could be done better and what needs improving. The Manager’s AQAA contained limited information and some areas had very little detail, for example about the development and progress of the service or how they had responded to some of the requirements made in the last inspection report. This information was considered as part of the inspection process and reflected as part of the report. Prior to the site visit, the manager was sent a variety of surveys to distribute and that asked questions that were relevant for each group, such as for residents, relatives, staff, care managers and healthcare professionals. Responses were received from relatives, staff and also from residents who were supported to complete them by staff and comments and responses are reflected throughout the report. The outcomes of the site visit were discussed with the manager throughout the day and opportunity was given for clarification where necessary. What the service does well: Bluebell Court provides an environment that is both pleasing and comfortable and residents clearly enjoyed the garden. There is a relaxed atmosphere and interactions seen and heard between staff and residents were respectful and friendly. A relative commented, “ provides a modern, clean environment”. All residents spoken with were satisfied with the food served in both quantity and quality. Comments included “the food is nice, it’s hot and I get enough to eat”, “food is not bad, and there is plenty of it, we get two choices” and “I don’t go hungry”. DS0000067279.V366253.R01.S.doc Version 5.2 Page 6 Residents and relatives complimented staff with comments such as “staff respond to the needs of residents very well”, or “the staff are friendly and obliging and I have been pleased with the care (relative) received,” and “staff are very approachable”. A relative was pleased that the resident could choose where they spent their time or whether to join in activities and said that it gave them peace of mind that (relative) is cared for in all (their) needs”. What has improved since the last inspection? What they could do better: The manager needs to ensure that the home is managed effectively to meet and promote the well being of residents. This must start with a full assessment of the persons needs so the manager can be sure the home has all the information needed to make a decision on whether they can meet these. The manager must ensure that care plans and necessary risk assessments are in place for all resident so that the manager can be sure that staff have the information to meet the residents’ needs from the outset. Medication must also be safely stored to ensure it remains effective in its properties and so promotes residents’ health and well-being. Staff training needs to be developed, including induction and in dementia care, so that all staff have the knowledge and skills necessary to meet residents needs and provide quality care experiences and outcomes for all residents. DS0000067279.V366253.R01.S.doc Version 5.2 Page 7 Opportunities for stimulation and meaningful daily life activities need to continue to develop and be available at an appropriate level for all residents. Comments from relatives included “would like to see staff having more time to sit and interact with residents” and a relative felt the home could improve by “providing adequate staffing levels according to residents’ needs”. Records regarding complaints need to be better organised and all complaints must be recorded. Records regarding safeguarding issues need to be better organised and securely stored. The registered provider must visit the home every month and write a report that shows that they have looked closely at the way the home is running to ensure resident wellbeing is promoted and that the home is well managed. 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. DS0000067279.V366253.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 DS0000067279.V366253.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, 3 and 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People thinking of moving to Bluebell Court can not be sure they will be given sufficient information about the home or that their needs will be fully assessed before admission to ensure these can be met. EVIDENCE: The statement of purpose was available and a copy provided by the manager. It had been updated this year and provided information in a clear and easy to read format. It needs to include more detail on some issues to fully meet the regulation such as details of the fire and associated procedures etc. The manager was unable to provide a copy of the service user guide on request advising that she did not know for sure what it was. The service user guide is relevant information about the home for prospective residents to help them to decide if it is suitable for their needs and preferences. The manager provided a copy of the colour brochures that are sent to prospective residents DS0000067279.V366253.R01.S.doc Version 5.2 Page 10 that contain some information about the home and the organisation, but do not provide the details required by regulation. The report of the last key inspection was displayed for people to see which is good practice. The organisations/manager’s own standards as set out in their statement of purpose states that in addition to any assessment carried out by a Care Manager, for example from Social Services, to establish what the person’s care needs are, “a further assessment of need will be carried out by the Registered Home Manager prior to your admission”. The manager’s AQAA states that part of their improvements in the last twelve months has been more comprehensive assessments carried out by trained staff. Files of recent people recently admitted were sampled to look at how well the manager had assessed their needs prior to admission to ensure that the staff skills and the facilities at Bluebell Court were appropriate to meet these. One file showed that a pre-admission assessment had been undertaken by a member of the management team, this was supported by a detailed assessment by the local social services team. There was no evidence on file to show that the manager had provided written confirmation to the person that, based on the assessment information, the home could meet their needs, as is required by regulation. The other file looked at did not have a detailed pre-admission assessment but there had been a bed enquiry form completed and a visit by the prospective resident. The manager confirmed that they had not undertaken a full assessment of the person’s needs, this even though this was not an emergency admission and the person had been admitted with their knowledge. There was no care manager assessment as the placement was privately funded. The manager was advised that they need to manage such situations and comply with regulation and good practice to ensure the wellbeing of the prospective resident. Bluebell Court does not offer intermediate care. DS0000067279.V366253.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 adequate. This judgement has been made using available evidence including a visit to this service. Some residents may not have an individual plan of care in place in a timely manner and some shortfalls in care planning, risk assessing and medication practices could have an adverse affect on outcomes for residents and their wellbeing. EVIDENCE: Five care plans were reviewed. The manager uses a system of assessing what areas of need a person has and developing a care plan based on problems/needs, rather than from a person centred approach. The manager said that they did not believe there should be too many care plan areas in place for each resident. Photographs were not available on three of the care plans sampled to help staff with identification, particularly of new residents, and to ensure the right person got the right care or medication. The manager said that they there were a few other care plans without photographs and that this was her area of responsibility to address. The manager had the camera on their desk and said DS0000067279.V366253.R01.S.doc Version 5.2 Page 12 they were to do the photographs that day, as the residents were recent admissions. Records showed however that the residents without photographs had been in the home for up to four weeks at the time of the site visit. A care folder was in place for one of the residents sampled and some areas of the persons identified needs had been documented. Other areas of identified needs, such as their diabetes or dementia, were not planned for. Some of the written instructions to advise staff on how the care was to be delivered on a practical daily basis contained inadequate information, such as equipment to be used for preventative pressure area care or that the person was to have bed rest to relieve pressure areas. Bedrails were in use for this person but there was no risk assessment to ensure they were safe equipment for their specific needs. The pre-admission assessment stated that the person was to be hoisted for all transfers, but no moving and handling assessment was available to instruct staff on working practices to safeguard the resident or themselves. The care plan was not signed by the person/their representative to show their agreement to it although the manager said this will be done with relatives in the near future. Relatives had signed the care plan of another resident, although the resident was considered able and had signed their own review notes, noting “ very happy with the care provided”. Aspects of some of the care plans sampled had more detail and were noted positively to include assessments including for dependency, falls, nutritional screening, body mass index and skin integrity to help staff to plan good care and reduce the risks for individual people. Some aspects of the care plans sampled were noted positively to remind staff to support residents’ privacy and dignity and also to allow people to the things they were able to themselves to retain skills and independence. Residents spoken with confirmed that staff knocked at doors and this was noted to occur during the site visit. This was also confirmed in a resident survey. The manager advised in the AQAA that something that they do in relation to health and personal care was individual care planning. In their AQAA, the manager said that they completed all resident paperwork within 72 hours of admission. The manager confirmed that a care plan was not in place for a recently admitted resident, advising that they believed they had up to 72 hours after admission to complete assessments. The manager was advised this does not comply with Regulation, of which as manager they need to be familiar, and they need to be proactive in managing good care planning to ensure quality care outcomes for residents from their first day of admission. The falls risk assessment for this resident was not completed, yet this was advised as one of the person’s main care needs/reasons for admission, along with mobility. There was no instructions for staff on how they were to meet the person’s care needs or wishes, for example in relation to food, medication, continence or mobility. DS0000067279.V366253.R01.S.doc Version 5.2 Page 13 The manager was unaware if the person had prescribed medication. The deputy manager confirmed that the relatives of the resident had brought some of the person’s medications the previous evening, and had brought the rest on the day of the site visit. These were just being written on to the records and the deputy confirmed this meant that the resident had not had their prescribed medication the previous evening. Care notes were routinely written once in a twenty four hour period, often after the end of the morning shift, limiting the amount of information available about how residents spent the rest of the day. Care notes sampled varied in their quality and many were repetitive or provided no sensible information, for example (residents) personal care needs were met before the shift, which does not allow for good monitoring of the person’s well-being and whether their care needs were being met. Each section of the care plan was routinely reviewed each month. These again were repetitive and not always followed through, for example a recent review of a residents care plan noted that they “got agitated at times”, but did not follow on to a review of, or implementation of a new, care plan to help staff to manage this in a supportive way for the resident and others. Surveys from two relative shows they felt the care home always met the needs of their relative, and five relatives felt they usually met people’s needs. One relative expressed the view that residents dont get enough fluids or that carers dont always notice care needs. The relative advised that when discussed, action is taken to address these concerns about the care, but it is not always continued. Another relative commented “very caring so far”. Completed surveys were received for five residents, four had been helped to complete the form by a carer and the fifth by a relative. Those completed with the support of a carer advised that residents always received the care and support they need including medical support. The person completing the fifth survey also agreed with this advising that they personally request all of what is required without any problem. Residents spoken with who were able to express a view said they were satisfied with the care provided at the home. The AQAA states that there are regular medication audits as an improvement in the last twelve months. A sample of medication administration records (MAR) and storage was reviewed. No omissions were noted on the MAR sampled, which is good practice and records tallied with the medications remaining in the blister packs. This helps to reassure that residents had their medications as prescribed. One resident’s medication records showed that they regularly refused their prescribed medication. There was no evidence that a GP had been contacted for advice or that a risk assessment had been undertaken to consider the residents wellbeing. A protocol was not available to guide staff on when to provide medications that are prescribed on an ‘as required’ basis to ensure residents receive these consistently and appropriately. Senior staff DS0000067279.V366253.R01.S.doc Version 5.2 Page 14 confirmed that the signatory list, which shows the signature and initials of the people deemed competent to administer medications to residents, was not accurate and needed to be updated. Staff spoken with confirmed that they had had updated medication training two to three months prior to this site visit. The AQAA does not advise on what action the manager the manager had taken to meet the requirements of the last inspection report relating to medication and in particular to medication storage and temperature management in medication storage rooms. A record of the temperature of the medication storage room on one floor showed that the temperatures regularly recorded were between 26°and 28° Celsius. The thermometer read 26°C at the time of the site visit although the door had been open for some time. This may cause some medications to deteriorate and lose their properties as a result of the environmental conditions. The need for adequate ventilation was highlighted at the last key inspection to the home and remains outstanding. DS0000067279.V366253.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While residents can expect varied and well presented meals, and while opportunities for social activities are improving, some may not receive the necessary consideration and support to satisfy their individual recreational, emotional or religious needs. EVIDENCE: The manager advises in the AQAA that 12 months ago they were “struggling to find an activities group” but that they now have family and friends plus two activity coordinators who have organised trips and entertainment. A list identified the planned events for each month such as in May there was a trip to the Sea life Centre with fish and chips in Southend, and three events planned for June. The manager advised in the AQAA that they are trying to raise funds to have a tail lift fitted to the minibus so that residents who use wheelchairs might also have the opportunity of going on the outings. Life histories were noted positively on some files and gave information that was relevant to and may interest residents. However, the social care plans were not always completed to help staff to support residents to enjoy meaningful activities in their daily lives. For one person living with dementia DS0000067279.V366253.R01.S.doc Version 5.2 Page 16 the plan of action to meet their social and emotional care needs was to encourage them to join in activities, send them on trips and to sit with them in the garden. There was no clarity as to what the person liked, how staff were to encourage them to join in, which activities or outings might be suitable or not for the person and whether they required any additional support, for example in staffing levels. One person’s assessed needs clearly identified a particular religious faith. This was not referred to in their plan of care and that was no evidence that their/representatives, views had been sought on this matter. A program identified which periods of time the activities coordinators would be in various areas of the home although there was no planned programme of daily activities. The manager advised that particularly on the dementia unit activities undertaken by the co-ordinators are what residents can accommodate at any particular time. Not all staff working with people living with dementia, including the unit supervisor, have had any training on this specialist area and this is included as a requirement under standard 30, to develop staff understanding and skills in supporting quality care outcomes for residents. Some residents may wish to be aware of what activities are planned in the home so that they can choose and plan to join in. The manager was recommended to consider presenting the information on activities available in a way that might be easier for people to read, understand and make active choices from such as using large print or pictorial formats. Three residents spoken with confirmed that they enjoyed the gardening activity that was occurring at the time of the site visit and one also said that they like going out to the local town, which they do get opportunity to do. Residents said that their visitors are welcomed and this was confirmed in a relative’s survey. Residents surveys completed with the assistance of staff advised that there are always suitable activities arranged by the home that they could take part in. A relative commented that they would like to see more interaction between the carers and the residents rather than seeing residents sat in front of the TV without a carer present. Another relative commented “a little bit more stimulation needed”. Residents spoken with said that they were satisfied with the meals provided at the home. Staff were heard to offer residents at choice of lunch and tea time meals during the morning. A four week rotating menu was displayed which showed a clear choice at all meals including the opportunity for cooked food at breakfast. It also clearly identified a choice of drinks and fresh fruit midmorning, choice of drinks and home baking in the afternoon and a choice of warm drinks and snacks in the evening. The manager is recommended to consider other ways of presenting the menu that might be easier for people to read, understand and make active choices from. One member of staff was observed supporting a resident at meal time, the resident was reluctant to eat all of the meal and the staff member patience and understanding, offering the resident alternatives and gently encouraging the resident to ‘eat what you can’. DS0000067279.V366253.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are able to raise concerns about the service and felt safe living in the home, however there was insufficient training or written guidance available for staff on safeguarding procedures. EVIDENCE: Information on making a complaint was displayed in the foyer. It did not have accurate information on contacting the Commission. It was recommended that the complaints procedure be written in a larger print to be easier for people to see. The manager said people are made aware verbally that they may raise concerns or make complaints. All surveys from relatives and all but one survey from residents said they would know how to make a complaint. Staff surveys showed they were clear on how to respond to issues raised with them. The manager said in the AQAA that 10 complaints had been received in the past year and all had been resolved within 28 days. There was a logging system and a matrix of complaints but outcomes were not always recorded so it was not easy to know what had happened. At the site visit, the manager said that two complaints were currently being investigated, one regarding missing laundry and one relating to some poor aspects of personal care and a lack of appropriate response from, mainly agency staff, when it was reported. On requesting information on safeguarding procedures records were seen in this file relating to another ongoing safeguarding issue. This does not DS0000067279.V366253.R01.S.doc Version 5.2 Page 18 demonstrate secure storage or effective management of records and issues relating to safeguarding investigations. The manager confirmed that a resident had made a complaint that was not noted in the complaints log. The manager advised in the AQAA that three safeguarding referrals had been made. The manager said she had not advised the Commission of this complaint/safeguarding issue or mentioned it during the inspection because it was ongoing and not yet concluded. The manager advised that not all staff have had training on safeguarding and this was confirmed on the training matrix, which shows that twenty-one staff have not received training on this topic. The manager advised that they have not yet had adult safeguarding training and had been waiting for one and a half years for the local authority to offer them a place. This does not meet the organisations/manager’s statement of purpose, which states that all staff receive training in protection of vulnerable people. Training records sampled at the inspection demonstrated that training had been provided to some staff on adult safeguarding, and staff members spoken with were aware of adult safeguarding procedures and were able to tell us what they would do if they had any concerns. Actual comments made included: (I would) ‘notify senior staff up the management line’. This is positive and evidenced that those staff spoken with were aware of action to take if they had any concerns, unfortunately this knowledge was not underpinned with any written guidelines or procedures in the home on the adult safeguarding process for the local area. Such procedures would ensure staff are supported in responding in an appropriate and consistent manner when issues of concern arise. The manager was recommended to obtain a copy of these and familiarise themselves with the current procedures and guidelines. DS0000067279.V366253.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to live in a pleasant and clean home that is suitable to meet their basic needs, but it may not always be safe or best support those people living with dementia. EVIDENCE: Bluebell Court provided a comfortable and homely environment for people to live in. The site visit included a tour of the premises during which it was noted that the home was very clean and tidy, and well decorated and maintained throughout, with no evidence of any unpleasant odours. Carpets and furnishings were of a good quality and the home was spacious and bright throughout. Accommodation is provided on all three floors, with communal lounges and dining rooms on each floor. Surveys within the home from relatives as well as comments received by the commission indicate some dissatisfaction with the current entry/exit system to the home, particularly the DS0000067279.V366253.R01.S.doc Version 5.2 Page 20 in the evening when staff were busy seeing to residents needs and relatives have to wait for a staff member to be free to open the door for them. Concern was also raised that some residents may try to get up to open the door and this may cause them to fall. The analysis of accident records sampled did not support this. There were eight bathrooms (three had fitted hoists) and three shower rooms. Hoists and wheelchairs were seen stored in some of the bathrooms, the manager acknowledged that this was not altogether suitable however there were no designated storage areas for such equipment. There were sufficient toilets to enable immediate access, and all private rooms in Bluebell Court had en-suite wc. People living at the home and able to express a view were happy with the way their home is kept clean, their comments included ‘my room is kept clean’ and ‘staff are very helpful and keep my room clean for me’. The care documents for a person living on the dementia unit identified that they experienced disorientation and had some difficulties finding their own room. It was discussed with the unit manager on the dementia unit that there was limited use of the environment, colour, lighting, signage/photographs etc to assist with orientation and recognition to follow good practice in current thinking on dementia care. The unit supervisor expressed great interest in this but advised that they as they had had no training and no experience working with people with dementia, they were unable to comment. The garden areas were on both sides of the premises as well as at the rear. There was seating and plant beds, with one resident having a small vegetable area they tended with staff help. Some areas of the home overlooked a large park to one side and the rear. The laundry was sited on the ground floor. Equipment and space provided was regarded as fully suitable for the numbers of residents accommodated in Bluebell Court. The manager confirmed that there had been no development with automatic closures on lounge doors as noted in the last inspection. Some of these doors were wedged open to allow residents easy access. The manager said these are always closed at night. One shortfall related to the premises was concerning a second floor window that was found to have the opening restrictor disengaged. This posed a serious risk to residents and staff as the window could be opened wide enough to fall from. The restrictor was re-engaged immediately and the room (empty) was locked. An immediate requirement notice was left with the manager on this issue and action has since been taken to ensure restrictors are checked. DS0000067279.V366253.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at Bluebell Court may not be supported by staff that have all the training they need to ensure they have the skills for their roles. Recruitment practices used promoted and protected residents’ welfare and safety. EVIDENCE: The home’s staffing rota was inspected and showed daytime staffing levels on the ground floor were three carers day time shifts and two carers at night. On the first floor there was one nurse and four carers on daytime shifts, with one nurse and two carers at night. Lastly on the second floor there was one senior and four carers daytime shifts and three carers at night. The manager said that each floor had a designated person in charge on every shift. Staff surveys indicated they felt that staffing levels were adequate to meet residents’ needs. In addition to the nursing and care staff, ancillary staff employed included a chef in charge and a cook covering seven days a week, three kitchen assistants, two laundry and domestic staff who also cover seven days a week, a maintenance person, an administrator and an activities coordinator. The manager said that in the past the home had used a high number of agency staff to maintain levels, but since new staff have been recruited this usage has reduced to perhaps only one agency shift a week. Comments from staff spoken with about the numbers of agency staff they work with included ‘there used to be a lot of agency used but its not so bad now’. DS0000067279.V366253.R01.S.doc Version 5.2 Page 22 Senior staff spoken with advised that there are a number of staff vacancies and most staff do additional shifts to cover these. Staff rotate around the units on regular basis to ensure they get to know all the residents. Residents were asked about the staff and comments made included: ‘staff are very helpful, but the activities are not all that much’, ‘the staff are mostly helpful’, the staff are ‘very nice and very kind’. Two visitors were also spoken with, comments included ‘some of the staff here are fantastic’. One relative surveyed thought that there were always staff with the right skills and experience to look after people properly, four thought there usually were and one person thought there sometimes were. Files were inspected for three staff employed since the last inspection. Evidence was seen to confirm that application forms had been completed, interviews held (with notes kept), written references obtained, written terms & conditions issued and criminal records checks undertaken. Copies of proof of ID, photographs and job descriptions were also on file. Records were not seen to confirm that these staff had all received induction training when they started work at Bluebell Court. The manager said that from the beginning of 2008 all new staff had been required to work through induction based on the Skills for Care common induction standards, but this did not apply to staff employed in 2007. As a result this training had not been provided to all staff employed since the last inspection. The AQAA states that the home offer staff a pleasant working environment and competitive wages, do well on staff training and that a high majority of their staff have worked at the home for a long period of time. Staff training files were inspected, all staff had a training record with copies of certificates included for evidence. Training subjects recorded in these included: first aid, medication, food hygiene, fire safety, infection control, care planning, person centred care, managing aggression, adult protection, palliative care, skin assessment and pressure care, epilepsy, Parkinson’s catheter care, wound care and NVQ. The matrix shows that 19 of 31 care staff achieved NVQ 2 and other staff confirmed they are either undertaking it or waiting for a place. Some files seen also included evidence of training in dementia however there was no confirmation that all staff that work in the home’s ‘dementia unit’ had received this training. The training matrix does not record dementia training but as all staff will work in that unit on rotation it needs to be provided for all staff. The senior person appointed as in charge of this unit confirmed that they had not had either training or experience in working with people living with dementia. In the AQAA, the manager cites the employment of a supervisor for this unit as one of the improvements in the past twelve months. The appropriateness of appointing a person who did not have either training or experience to supervise this specialist unit/area of care was discussed with the DS0000067279.V366253.R01.S.doc Version 5.2 Page 23 manager who made the appointment. The manager said they were aware of this training need and they were looking at accessing a training provider to meet the shortfall. There is a also a good practice recommendation in this report concerning staff who are employed to offer activities to residents, that they receive training appropriate to their role. This is included as at the time of the inspection there was no evidence that this training had been provided to staff. This does not meet the organisations/manager’s statement of purpose, which states that all staff receive training in Dementia Awareness. DS0000067279.V366253.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): 21, 33, 35, 36, 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Shortfalls in management arrangements in the home identified throughout this report could adversely affect outcomes for residents. EVIDENCE: The manager, who is a qualified nurse and registered with the Commission since the last inspection, said they had undertaken a training course in dementia, but had had no previous experience relating to managing a care home. The manager advised that they have however, worked as a unit manager in another care home for twenty months. The manager explained that they are organising their own Registered Managers Award training so that they can access this as soon as possible. DS0000067279.V366253.R01.S.doc Version 5.2 Page 25 This inspection process has shown shortfalls in management, for example in relation to effective assessment, care planning management, knowledge/ management of current safeguarding issues and lack of knowledge of required standards and regulations and have a negative impact on care outcomes for residents. Areas of weakness in the manager’s organisational skills have been highlighted, such as ensuring there are photographs of all residents to support identity recognition for staff on the various units administering care or medication, and an unworried approach to addressing these. There is also some evidence noted of non-compliance with their own stated benchmarks, such as their statement of purpose and limited evidence in their AQAA of their understanding of the need to provide appropriate information. In their AQAA, the manager stated that they “now have a more structured management team within the home” but does not expand on how this has improved the service or outcomes for residents. Since the last inspection, a deputy manager has also been appointed. The manager also stated in the AQAA that one of the ways management and administration of the home has improved in the last 12 months is that they have “more leadership from the local council regarding management issues”. The manager needs to consider that it is they and not the local council who have the responsibility to ensure effective management of the home. Regulation 26 requires the registered provider to visit the home monthly to assess how well it is running and meeting the needs of the residents. Records available show that this is happening every two months rather than monthly as required. It is noted positively that residents and relatives meetings are now taking place bimonthly and minutes of these were seen. Survey forms were seen to be freely available next to the visitors’ signing in book. The manager confirmed that these are collated by head office. The most recent audit showed satisfaction with many of the services provided and noted an improvement in the provision of social activities. There were some recurrent issues of concern regarding the laundry and the high number of agency staff used that did not have a good knowledge of residents needs. It was recommended that the outcomes of the quality assurance system be developed into an action plan and shared with those who had contributed. The system for managing residents’ money was sampled. Individual records and receipts were available. Safe storage was available and residents would have access to their money at weekends should they require it. There was a staff supervision process and format in place at this home and records of this were seen. The format used included 1-1 discussion between the supervisor and staff member on workload, performance, personal development, skills and staff care. Staff spoken with confirmed that they had received supervision and found it useful, unfortunately records did not confirm DS0000067279.V366253.R01.S.doc Version 5.2 Page 26 that the timescales of these meetings had met the recommended six times a year minimum. Accident records were clearly organised and completed. They were regularly audited by the manager, which is good practice, to look for trends that could be used to inform risk assessments and prevent future events. Other than the concern relating to the upstairs window restrictor advised in the section on Environment, no other health and safety issues were noted. Sampled inspection certificates were available relating to the fire alarm, the emergency lighting, gas, the passenger lift and the hoists were current to support resident safety and the weighing scale had recently been re-calibrated to support accurate monitoring of residents’ weight. DS0000067279.V366253.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 2 X 1 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 2 2 2 DS0000067279.V366253.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5(1) Requirement A service user guide must be produced to tell interested people about the home and include the information required by regulation. A full assessment must be undertaken of the needs of any prospective resident prior to admission so that the manager can be sure that the staff skills and the facilities at Bluebell Court are appropriate to meet these. The home must confirm in writing to each prospective resident that, based on their assessment, they are able to meet the resident’s needs in respect of their health and welfare. This is outstanding from the last inspection. Care planning at the home must identify, and be effective in meeting all residents’ assessed needs and give staff clear DS0000067279.V366253.R01.S.doc Timescale for action 01/08/08 2. OP3 14(1) 11/06/08 3. OP3 14(1)d 11/06/08 4. OP7 15(1) 01/09/08 Version 5.2 Page 29 instructions on how to apply these in daily practice to ensure that residents get the care they need and in the way they prefer. This is outstanding in part from the last inspection. 5. OP8 13(4) Risk assessments must be devised for all areas of assessed risk so that risks to residents can be minimised and health and well being promoted. Residents’ medication must be stored appropriately to maintain its properties and safeguard residents. This is outstanding in part from the last inspection. 7. OP12 16 (2) m &n All people residing at the care 01/08/08 home must have their social care needs met to ensure they have stimulation to promote their wellbeing. The manager must keep accurate records of all complaints received to demonstrate that they were fully investigated. All staff, including the manager to receive training relating to safeguarding. This will ensure that staff have the knowledge and confidence to deal with any situations that arise, that the manager will manage them effectively and residents and others will feel assured that they will be kept safe. Ensure that staff working at the care home receive the appropriate training to the work DS0000067279.V366253.R01.S.doc 01/08/08 6. OP9 13 (2) 01/08/08 8. OP16 22(3) 11/06/08 9. OP18 13(6) 01/09/08 10. OP30 18(1) 01/09/08 Version 5.2 Page 30 they perform so as to best meet residents needs. This refers specifically to training relating to those conditions associated with the needs of older people and to structured induction training. 11. OP31 10(1) The manager of the home must manage the home with skill and competency so as to ensure the smooth running of the home and that residents needs are met. Visits must be undertaken monthly by the registered provider to monitor and ensure that the home is running effectively to meet residents needs and to provide support to the manager. The manager must ensure that the premises are safe for residents and that window restrictors and other safety devices are effective. 11/06/08 12. OP33 26 01/08/08 13. OP38 13(4) 11/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP1 OP9 OP9 Good Practice Recommendations The statement of purpose should be expanded to include more information on for example fire and associated emergency procedures. Protocols should be in place to give guidance to staff for medications prescribed on an ‘as required’ basis. The staff signatory list should be updated so that there is accurate information on those staff the manager has deemed competent to administer medication to residents. DS0000067279.V366253.R01.S.doc Version 5.2 Page 31 4. OP14 Information should be made available to residents in a way that they may best understand, for example with menus and activity plans so that people have the best opportunities to make choices. The complaints procedure should be updated to provide accurate contact details for the commission and be in a format suitable to the needs of the residents. Consideration should be given to improving the environment for people living with dementia in line with current good practice guidelines, for example clear signs, symbols and photographs for recognition and orientation etc. All staff should have supervision at least six times each year, to provide them with support and opportunity for reflection on practice and development needs. The manager should review their recording systems for safeguarding referral/investigations and complaints and ensure they are well organised, accessible and secure. 5. OP16 6. OP19 7. OP36 8. OP37 DS0000067279.V366253.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 DS0000067279.V366253.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!