CARE HOMES FOR OLDER PEOPLE
Bluebell House 408 Boothferry Road Hessle East Yorkshire HU13 0JL Lead Inspector
Sarah Urding Unannounced 13 September 2005 09:00 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 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. Bluebell House J53_s19650_Bluebell House_v247073_140905_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Bluebell House Address 408 Boothferry Road Hessle East Yorkshire HU13 0JL 01482 649234 01482 649234 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Joan Todd & Mrs David Todd Mrs Joan Todd Care Home 26 Category(ies) of OP Old Age (26) registration, with number DE(E) Dementia - over 65 of places Bluebell House J53_s19650_Bluebell House_v247073_140905_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 20th October 2004 Brief Description of the Service: Bluebell House is a care home offering care and accommodation for up to 26 older people of both sexes including those with dementia related needs. The home is situated in well maintained grounds close to the humber bridge. The accommodation consists of 18 single bedrooms and 4 shared rooms none of which have en-suite facilities. Service users have a choice of lounge/dining facilities including a conservatory. A number of bedrooms overlook a courtyard garden. The grounds are easily accessible to service users including wheelchair users. The first floor is accessible by stair lift. There is a small car park to the front of the home and good road and public transport links ensure the home is convenient for visitors. Bluebell House J53_s19650_Bluebell House_v247073_140905_Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over a period of five and a half hours. The inspector looked around all parts of the building and a number of records and policies were inspected. Fifteen of the Twenty-three residents in the home were spoken to and four members of staff were also spoken to. What the service does well: What has improved since the last inspection? What they could do better:
Care plans need to reflect how staff should care for service users foot, oral and optical health care needs. The recording of medication requires more
Bluebell House J53_s19650_Bluebell House_v247073_140905_Stage 4.doc Version 1.40 Page 6 accuracy, especially when administering controlled drugs. Current practice does not ensure that service users are safeguarded in this area, as excess drugs cannot be accounted for. The recruitment of staff must also be more robust. POVA First checks and references are not in place prior to staff starting work. This is poor practice and increases the risk of harm to service users. Not all staff were clear about reporting procedures should an allegation be made by a service user. This must be addressed as a priority. 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. Bluebell House J53_s19650_Bluebell House_v247073_140905_Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Bluebell House J53_s19650_Bluebell House_v247073_140905_Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 6 The home is able to meet the needs of service users owing to a thorough assessment on admission. EVIDENCE: Service users undergo a thorough assessment of needs prior to admission, which demonstrates that the home works in partnership with service users, their families and health professionals to glean full information about service users lives. The assessment covers all aspects of standard 3.3 and is completed in detail and well presented. The assessment links clearly to the care plan. The home is not providing intermediate care at the present time. Bluebell House J53_s19650_Bluebell House_v247073_140905_Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 Service users health care needs are well met by the home. The inaccurate recording of medication places service users at risk. Service users are respected and treated with dignity by the staff. EVIDENCE: All service users have a detailed plan of care that provides staff with the information they need to ensure needs are met. This links in to the home’s assessment on admission and is reviewed on a regular basis and when needs change. A minor addition to the care plan is required so that all needs identified in the assessment are addressed. Reference to how staff should meet oral, foot and optical health care needs should be made. Service users health care needs are being clearly identified and met by the home. There was evidence in service users records that all health care needs were being consistently met. Two service users were observed to have dirty fingernails at the time of inspection. This was raised with the registered manager who dealt with this immediately. The inspector observed staff giving both service users a manicure. The inspector believes this to be an oversight as there was evidence in service users records that regular hand care takes place.
Bluebell House J53_s19650_Bluebell House_v247073_140905_Stage 4.doc Version 1.40 Page 10 The home has a comprehensive medication policy and trained staff administer medication to service users. Current practice does not safeguard service users in this area, as the recordings of administration are not consistently accurate. Gaps were left in the administration record for service users who are in hospital, which could indicate that service users are not receiving prescribed medication. The home must ensure that hospital stays are recorded as such. Controlled drugs in the home are not being accurately recorded. Records for one service user indicated that all tablets had been administered last month. However there was one tablet left over. This indicates that on one occasion the service user had either refused medication or it had not been given. The record was signed by two staff incorrectly as being given. This indicates that staff are not witnessing the administration of controlled drugs as required. Practice must improve in this area and the excess tablet be returned to the chemist for disposal to prevent misuse. All service users spoken to spoke warmly about the staff in the home. They consistently stated that their privacy was respected and dignity upheld during personal care tasks. Staff are aware of the sensitivities involved while carrying out personal care. One area of practice that appeared to compromise the confidentiality of service users was a telephone call taken by a member of staff about a service user. This took place in the communal lounge. This was raised with the registered manager who stated that phone calls of a confidential nature would normally take place in the office and that the member of staff had not wanted to disturb the inspection process. This is accepted. Bluebell House J53_s19650_Bluebell House_v247073_140905_Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 Social activities are well organised, creative and provide stimulation and interest for people living in the home. Meals are nutritious and balanced and offer a healthy and varied diet for service users. EVIDENCE: Service users lifestyle in the home satisfies their social, cultural religious and recreational needs. This was evidenced in care plans and in talking to service users. A range of weekly activities were offered in the home including movement to music, carpet bowls, dominoes and guessing games, which service users were really positive about. Records are kept of who takes part in the activities. This is positive as it enables the registered manager to monitor that all social needs are being met. Religious services are held in the home and service users are able to attend church services in the community if they wish. One service user has regular communion in her room. Service users are involved directly in making decisions through residents meetings and a residents fund enables service users to go on trips out. This is money raised through raffles and fates held at the home. This is good practice. Contact with family and friends is promoted well by the home. Service users were positive about being able to see their friends and family when they wish.
Bluebell House J53_s19650_Bluebell House_v247073_140905_Stage 4.doc Version 1.40 Page 12 Service users are encouraged to maintain choice and control over their lives on a daily basis. Staff spoken to described how they ensure that service users are consulted with and empowered to make their own decisions. This ensures that service users maintain their independence for as long as possible and that staff are aware of treating people in a positive and inclusive manner. A number of people in the home commented about the food and how good it was. One service user said, “The food is good. They try to please us as much as they can”. Menus were found to be well balanced and varied. Choice is offered at every meal and the cook has a list of the likes and dislikes of all service users. Bluebell House J53_s19650_Bluebell House_v247073_140905_Stage 4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 Arrangements for complaints and the protection of vulnerable adults are handled well and ensure that service users feel listened to and protected. EVIDENCE: The home has a clear complaints procedure in place. Service users spoken to said that they had no complaints about the home but felt confident to raise issues of concern if they arose. Complaints are recorded in a diary and addressed by the manager. There had been a number of minor complaints since the last inspection. Records evidenced how the complaints were dealt with and their outcomes. It is good practice to evidence all issues as it demonstrates an open approach and the desire to ensure that service users are satisfied with their care. The home has an appropriate policy in place for the protection of vulnerable adults. The majority of staff spoken to were clear about reporting procedures should a service user make an allegation and around the indicators of abuse. Some staff however lacked clarity around the whistle blowing procedure. The registered manager has already identified the need for further training in this area and a protection of vulnerable adults course is to be held in the near future. The registered manager must ensure that all staff have an understanding of reporting procedures. Service users spoken to said that they felt safe when being looked after by staff. The local authority guidelines for the protection of vulnerable adults are in place. Bluebell House J53_s19650_Bluebell House_v247073_140905_Stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 26 Service users live in a safe and homely environment, which is well maintained. EVIDENCE: The home is clean, well presented and homely. A planned programme of maintenance is in place. Policies for the control of infection are in place and followed in practice. Service users spoken to were positive about standards of cleanliness in the home. Laundry facilities in the home are appropriate and meet the needs of the service users. Service users commented on the cleanliness of their clothes on the return from the laundry. Bluebell House J53_s19650_Bluebell House_v247073_140905_Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 Service users needs are met by the good level of staffing and training provided in the home. The procedures for the recruitment of staff are not robust and do not offer protection to people living in the home. EVIDENCE: The home is well staffed at all times. Three staff are on duty throughout the day, supported by two housekeepers and a cook. Two staff are on duty at night. A senior member of staff is on duty at all times supported by the manager. Recruitment practice in the home requires improvement so that service users are safeguarded. CRB checks and references are not in place prior to staff starting work but have been subsequently obtained. This must be addressed. POVA First checks must be in place prior to staff starting work if CRB checks are delayed. Telephone calls to referees must be made prior to appointment if there is a delay in written response. Outcomes of these calls must be recorded. Written references must follow in every case. Staff are well trained and undergo induction and foundation training. As identified previously in this report the registered manager must ensure that all staff understand the reporting procedures following an allegation. Bluebell House J53_s19650_Bluebell House_v247073_140905_Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 37, 38 High levels of consultation and regular reviews by the manager ensure that service users are looked after in an environment that is both safe and inclusive. Some minor areas require attention in order to ensure that service users are safeguarded in all aspects of care. EVIDENCE: The home operates an effective quality assurance system that seeks the views of service users, staff, visitors and health professionals on a regular basis. There is a monthly audit system in place that looks at key areas aimed at improving standards. Issues arising are recorded as is the action taken in response. This is good practice. Service users are protected by the financial procedures of the home. The home does not act as appointee for any service users and looks after money appropriately. Written records of all transactions are accurately maintained.
Bluebell House J53_s19650_Bluebell House_v247073_140905_Stage 4.doc Version 1.40 Page 17 The home has detailed policies and procedures in place. Most records are kept appropriately. Some elements of service users records are not in place. Photographs of service users were not kept by the home in every case and must be as specified in schedule 3. Generally the home operates in the best interests of the health and safety of service users and staff. All safety checks are carried out within the specified time frame and policies are in place for safe working practice. One area requires attention. The maintenance check for the bath hoist was overdue and must be carried out with priority. All staff receive health and safety training. Bluebell House J53_s19650_Bluebell House_v247073_140905_Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 4 x 3 x 2 2 Bluebell House J53_s19650_Bluebell House_v247073_140905_Stage 4.doc Version 1.40 Page 19 NO Are there any outstanding requirements from the last inspection? 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 7 Regulation Requirement Timescale for action Oct 31st 2005 Immediate and ongoing 2. 9 3. 29 4. 37 5. 38 12, 13, 15 Care plans must evidence how all needs are to be met. To include reference to foot, oral and optical care. 13 The registered manager must make arrangements for the safe administration of medication. Accurate recprds must be kept. Two members of staff must witness the administration of controlled drugs. The excess tablet must be safely disposed of. 19 The registered manager must ensure that CRB checks and references are in place prior to staff starting work. 17 All records outlined in schedule 3 must be held in the home. To include photographs of all service users. 12, 23 The registered manager must ensure that all safety checks are carried out in the specified timescale. To include the bath hoist. Immediate and ongoing Oct 31st 2005 Sept 30th 2005 Bluebell House J53_s19650_Bluebell House_v247073_140905_Stage 4.doc Version 1.40 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 18 Good Practice Recommendations The registered manager should ensure that all staff understand the procedure for reporting incidents of abuse. Bluebell House J53_s19650_Bluebell House_v247073_140905_Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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