Random inspection report
Care homes for older people
Name: Address: Bluebell Court Stanley Road Grays Thurrock Essex RM17 6QY one star adequate service 16/12/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Diane Roberts Date: 1 6 0 4 2 0 0 9 Information about the care home
Name of care home: Address: Bluebell Court Stanley Road Grays Thurrock Essex RM17 6QY 01375369318 01375369346 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Primrose Care Home Limited care home 80 Number of places (if applicable): Under 65 Over 65 30 80 10 dementia old age, not falling within any other category physical disability Conditions of registration: Date of last inspection Brief description of the care home 0 0 0 1 6 1 2 2 0 0 8 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
Care Homes for Older People Page 2 of 11 Brief description of the care 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. Care Homes for Older People Page 3 of 11 What we found:
Due to a resident recently developing a home acquired pressure sore, a review of all residents with pressure sores currently in the home was undertaken. It was noted that whilst there was one, unacceptable, home acquired pressure sore, there were currently seven residents with hospital acquired pressure sores in the home that the team were managing to heal. Records showed that residents had the appropriate pressure relieving equipment in place and that the wounds were monitored and were healing. The team were also monitoring the residents weight and nutrition to ensure that the healing process was optimal. Residents were seen to be being weighed regularly, but it is recommended that a reporting system is put in place whereby the manager of the home is made aware of the weekly or monthly results, so they can ensure that the appropriate action has been taken when required. It was also evident from the records that residents who had spent time in hospital had often lost weight and were putting it back on once back in Bluebell Court. It was also evident from the risk assessment records that some residents with a high risk of pressure sores had not developed any in the home. Where appropriate residents are on fluid and food intake monitoring charts and those seen were generally completed well with only the odd inconsistency. From the care plans, staff do need to be sure what the management of residents is with regard to pressure relief over the whole 24 hr period as there was seen to be some confusion over whether residents are turned at night, as well as during the day. The care plans did show a good level of detail to guide staff and body maps were also in place. Since the last inspection, the providers have increased the staffing levels on the nursing floor. Staffing levels on each floor were discussed with the regional manager and are based upon the dependency of the residents and kept under regular review. The home currently has no care staff vacancies but continues to advertise for staff to ensure shifts are covered and agency staff are not used. The home has one part time vacancy for a registered nurse and they are looking to appoint a clinical lead for the nursing floor to help improve standards. Staff rotas show that overall they are generally keeping to their current set levels with only the odd shift down by one person, where they have not been able to get cover. The vacant managers post has been advertised and the home is currently being managed by managers from other homes and the senior management team from the company. Some of the senior care staff on duty are currently in an acting capacity whilst they undergo their probationary period in this role. Once completed satisfactorily, they can take up post permanently and with less supervision. Records showed that these staff are not able to start in an acting role until they have completed their 12 week medication course and in house competencies. Records were seen of those staff who had completed their training and those who had not were still shown as working as care staff on the rotas. Three care staff files were reviewed in relation to recruitment, training, supervision and the management of any disciplinary matters. With regard to recruitment, all the required documentation and checks were seen to be in place, including CRB checks and references. Records show that staff are attending training sessions, some more consistently than others. The management team have completed a workforce development plan which they are going to implement. Whilst the training includes
Care Homes for Older People Page 4 of 11 dementia awareness, which has improved since our last visit, there are still significant gaps in the staff training programme which the management team are currently trying to address. There is evidence of supervision being undertaken on a 3 monthly basis. Unfortunately it was noted that two staff incidents of possible abusive behavior towards residents were not seen to have been managed in line with adult protection guidance and had not been reported as possible abuse. The management of staff in relation to such incidents was discussed with the regional manager, who was unaware of one of the incidents. She was advised to discuss this with the local adult protection team to progress further. Both staff files showed that they had attended training in dementia awareness and challenging behavior. On touring the home it was noted that there was an odour control issue on the second floor unit that needs addressing. Residents were noted not have drinks available to them during the course of the morning. Staff had put jugs of juice and cups in the lounge but had not actually given any out and the needs of the residents means that they would be unlikely to facilitate this themselves. It was also noted in this unit that when the tables were laid for lunch, staff had only given the residents forks to eat with, which can deskill them and does not promote self worth. It was also noted that the residents still have plastic coloured beakers and not glasses to drink from, which would be more age appropriate. A review of the manual handling equipment available was undertaken by touring the home with the regional manager. A sufficient range of lifting equipment was seen around the home on all floors and on discussion with staff, they confirmed that the amount available was satisfactory. The regional manager also confirmed that two more lifting belts were on order. Hand washing facilities were checked around the home and were found to be satisfactory along with the supply of protective clothing. Staff spoken to also confirmed that the supply was fine. The manager said that during a recent outbreak, an emergency supply had to be ordered but they never actually ran out. What the care home does well: What they could do better:
Whilst the management team are aware, they do still need to improve upon the staff training and supervision programme in the home to help ensure that residents are cared for by a competent team. The management of possible adult protection matters needs to be more robust with management recognising the need to follow internal and external procedures and guidelines to ensure the best outcomes for residents in the home.
Care Homes for Older People Page 5 of 11 Through training and staff supervision, the care of residents with dementia in the home needs to improve and be more person centered. Staff need to understand the needs of residents and also focus upon their strengths and the retention of skills. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 12 Residents care plans must be 14/03/2009 written in detail and be person centered as far as possible So staff have sufficient guidance to meet the residents needs in the way that they would wish. 2 8 12 Ensure that risk assessments 14/02/2009 are correct, followed and linked to the residents care plan. So that risks are minimised by correct management. 3 12 16 (2) m & n All people residing at the 01/08/2008 care home must have their social care needs met to ensure they have stimulation to promote their wellbeing. 4 12 12 Routines of the day, including the provision of activities from staff, should be resident led and a social care plan need to be in place. So that the care provided is based upon residents needs and preferred routines and 31/03/2009 Care Homes for Older People Page 7 of 11 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action that their social care needs are met. 5 19 13 Keep all parts of the home, as far as possible, free from COSHH hazards. To ensure resident safety. 6 30 18 Ensure that staff have the 31/03/2009 training they need to undertake their responsibilities and meet residents needs. Especially in relation to caring for people with dementia. So that residents benefit from a competent staff team. 06/02/2009 Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 18 13 In cases of possible abuse the correct procedures for managing such issues must be followed. To ensure that residents are protected and that the matter is dealt with correctly. 30/06/2009 2 30 18 The staff team at the home 31/07/2009 must be appropriately trained for the work they are expected to undertake, with particular emphasis on the care of people with dementia. So that residents are cared for by a competent staff team who understand their needs. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 8 A reporting system is recommended so that management are aware of the results of residents weights in the home
Page 9 of 11 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations on a weekly or monthly basis as appropriate, to ensure that the correct action is taken as needed. Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - 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!
