Inspection on 15/05/08 for Bluebell Lodge Care Home

This inspection was carried out on 15th May 2008.

CSCI found this care home to be providing an Adequate 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 Lodge Care Home 26/11/07

Bluebell Lodge Care Home 07/02/07

Bluebell Lodge Care Home 29/06/06

Bluebell Lodge Care Home 12/10/05

Bluebell Lodge Care Home 25/05/05

Bluebell Lodge Care Home 29/11/04

Bluebell Lodge Care Home 11/05/04

Bluebell Lodge Care Home 20/11/03

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

CARE HOMES FOR OLDER PEOPLE Bluebell Lodge Care Home Forest Lane Chippenham Wiltshire SN15 3QU Lead Inspector Alyson Fairweather Unannounced Inspection 15th May 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bluebell Lodge Care Home DS0000040675.V361825.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. Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bluebell Lodge Care Home Address Forest Lane Chippenham Wiltshire SN15 3QU 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) 01249 443501 01249 447506 bluebell.lodge@hotmail.co.uk Chippenham Limited Vacant Care Home 19 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (19) Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users who may be accommodated in the home at any one time is 19. Not more than 1 service user aged 65 years and over with a mental disorder may be accommodated at any one time. Not more than 1 service user in the age range 50 - 64 years may be accommodated at any one time. This person may only occupy the accommodation referred to in the variation application dated 27 March 2004 for respite or intermediate care and for a period not exceeding 4 weeks (except by prior consultation with the Commission). This bedroom is numbered 19 and located on the first floor immediately next to the medication storage room. The room may not be used for any mental disorder placement. 26th November 2007 Date of last inspection Brief Description of the Service: Bluebell Lodge is registered to care for nineteen older people. Within the nineteen places, one room is designated for respite care. The home is located in a residential area of Chippenham, and offers easy access to local amenities. It is situated in a quiet cul-de-sac, with ample parking to the front of the home. To the front of the house is a well-tended lawn with trees, and there is a large, secluded garden to the side and rear of the house. There are 17 single bedrooms and one twin room. Residents can choose to bring some of their own possessions with them when they move into Bluebell Lodge, and many have televisions, radios and small pieces of furniture. All contain en-suite toilet or bathing facilities and are located on both the ground and first floors. A passenger lift is available to give access to all areas. The communal areas of the home consist of two lounges and a separate dining room. All areas are comfortable, homely and furnished to a very high standard. The home does not provide intermediate or nursing care. Some residents are funded by the local authority, and these fees vary from £359 to £385 per week. Residents who pay their own fees pay £520 per week, and respite care fees are £525 per week. Additional charges are made for hairdressing, and various other sundry goods. Bluebell Lodge Care Home DS0000040675.V361825.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 1 star. This means the people who use this service experience adequate quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This unannounced inspection took place over one full day in May. Several residents and members of staff were spoken to, as well as the cleaner, the activities co-ordinator and the owners of the home, as well as a visiting district nurse. Various documents and files were examined, including care plans, health & safety procedures, risk assessments, medication procedures and staff training files. Mr Mackey also provided us with an Annual Quality Assurance Assessment. Following two inspections last year, when it was felt that the service was underperforming, we asked the providers to draw up an improvement plan. This was so that they could show us how they planned to make things better. They invested a great deal of time doing this, and both they and the home’s staff team have worked hard to implement the improvements. The providers have appointed a new manager, although this person was not yet in post on the day of the inspection. What the service does well: Residents said they enjoyed living in Bluebell Lodge, and their relatives spoke highly of the staff, saying they were very well looked after. Links between residents and their families, are supported and encouraged by staff, and they try to maintain people’s independence as much as possible. The home has employed a part time activities worker who has spent time getting to know residents’ likes and dislikes and is therefore able to base any activities around individual people. She has many contacts and has arranged visits and talks for residents, as well as arranging for a mobile library to visit. People’s interests have been recorded and catered for inside and outside the house. There has been a talk from someone about Lacock Abbey, and a trip is being organised to visit the gardens there. She also visits people who spend time in their own room, and has given some people a hand massage. She has set up activities for individuals and groups to take part in. One resident likes Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 6 poetry and being read to. Another is very interested in horticulture and showed us various plants in the garden. One relative said recently: “I made the comment last year that the residents would benefit from communal activities. This has been implemented with soft ball games, quizzes and various out What has improved since the last inspection? What they could do better: Staff were observed to be giving medication to a resident in an unsafe manner. The medication was taken to the resident and left on a table. The staff member had signed to say that the medication had been taken before it was even given to the resident. This was extremely risky practice, as the medication could have been dropped, in which case the resident would have been without, or another resident could have swallowed it, with potentially severe consequences. The provider has been told to ensure staff do not do this again. Before people move into a care home, the staff gather as much information about them as possible, so that they can be sure they can support them. This assessment information was much better than before. If there are any problems, a risk assessment should then be done. However, there was one instance where someone had come from hospital and moving around was difficult. The staff had failed make sure that all the possible areas which might Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 7 get pressure damage had been assessed, even though this issue had been raised with them before. The provider has been asked to make sure that this matter is dealt with. After moving into a care home, each resident has a care plan drawn up. Once again, there was a lot of good information on these care plans, but one in particular had not been updated, even though the person’s needs had changed. They were asked to make sure they did this at the last inspection, and have been once again. 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. Bluebell Lodge Care Home DS0000040675.V361825.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 Bluebell Lodge Care Home DS0000040675.V361825.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 Prospective residents do not have enough information to make a choice about whether they would like to stay in the home. Their needs, hopes and goals are assessed and recorded before they move in to the home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s Statement of Purpose and Service User Guide were in the process of being revised, and is waiting for the new manager to participate in this. They were therefore not ready for inspection. The provider was asked at the last inspection to ensure that the home’s Statement of Purpose contains information relating to the qualifications and experience of the registered provider and the manager, as well as staff. It should outline the staffing structure and give details of the home’s complaints and fire procedures. This requirement has been continued. Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 10 Senior staff usually meet with any prospective resident and family as part of the assessment process, and they collect various pieces of information regarding their needs. One new resident’s file was examined, and there were various assessments, including those for physical and mental health, sleeping patterns and eating likes and dislikes, as well as comprehensive discharge information from a stay in hospital. Discussions with staff and observations of care indicated that the home had provided relevant aids for this person. The resident was weighed on admission, so in the future any weight loss or gain can be monitored. However, this person was immobile in bed a lot of the time, using a wheelchair at others. The assessment information noted that both legs were being dressed because of pressure ulcers, although the sacral area was intact. The district nurse was seen to be involved with dressing the legs, but there was no risk assessment in place which would show how the home would manage to maintain skin integrity of the sacral area, and no evidence of any care plan for managing pressure care. The manager has been told that where assessment information indicates a resident is at risk of pressure sores a risk assessment must be put into place to show how the home will manage the situation. A scoring system was used, and the number of ticks was added up at the end of the form. There was no guidance about what these scores meant or what action should be taken next. It is recommended that where scoring systems of assessment are used, these should explain clearly how the rating is reached and what must be done at this stage. There are no intermediate care beds in Bluebell Lodge. Bluebell Lodge Care Home DS0000040675.V361825.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 Residents have their health, personal and social care needs set out in care plans. Their health needs are mainly met. Residents are protected by the home’s medication policies and procedures, although poor practice can sometimes put them at risk. They feel they are treated with respect and their right to privacy is upheld. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection, the owner has made extensive efforts to improve systems for health and personal care in the home, including developing quality monitoring systems and the appointment of a new manager. This was reflected in the improvement plan sent in after the last inspection and the home’s revised annual quality audit sent in prior to this inspection. Each resident in Bluebell Lodge has their own care plan. Information on care plans includes sleep routines, eating, communication, mobility and personal Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 12 care needs. Whilst talking to staff, it was clear that they were aware of individual’s needs. Care plans now contain a personal profile of each resident, and there were good risk assessments on file relating to mobility, nutrition, bathing, falling out of bed and mental health. These were all being reviewed on a regular basis. One person’s care plan said that turning in bed was required, although there was no turning chart in the room to evidence that this had been done. In discussion with the district nurse, it was said that in fact there now was no need for turning. The care plan had not been updated to show the improvement in the resident’s mobility. The providers have been asked to make sure that all care plans are updated when there is a change in residents’ needs. People all have their own GP and see healthcare professionals as and when needed. There was evidence of optician and dentist visits, as well as district nurses services being employed. One resident’s care plan said that he now requires turning in bed to relieve the pressure . A new profiling bed and a new hoist had been provided. There was a risk assessment in place relating to how to avoid pressure sores on heels but none in relation to the sacral area. The providers have been asked to ensure that people with mobility difficulties have risk assessments which highlight the risk to all pressure areas. Some people who are in bed most of the time are using a fluid chart and a turning chart. These were now all being completed. However, there had been no tally made of people’s fluid intake each day. The chart showed reference to “sips” and “refused”. In discussion with staff, they did not know how much fluid was needed in a day, or how to measure fluid output if this is required. Some charts showed that residents had drunk under 850 mls. This means that they could become dehydrated. The providers have been told to take professional advice about the fluid intake requirements by these individuals. One resident had been discharged from hospital using oxygen. The machine is fitted in the bedroom and piped through a nasal tube. This electric machine is on all day, and emergency arrangements have been made in case of an electricity cut. One staff member has been shown how to work the small machine, and has shown other staff. The emergency supply involves the use of a cylinder, and staff have had no training in this. The providers have requested training for all staff in the use of oxygen, but this has not happened yet. They have been asked to ensure that this is now done. Most residents were now being weighed monthly, although there were some people who could not weight bear and therefore couldn’t use the scales. It is Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 13 recommended that suitable weighing scales should be provided so that all residents can be weighed. The home has a policy in place for all medication, and all staff have medication training when they first start work. Medication is kept in a locked trolley in a locked room on the second floor. One designated member of staff is responsible for the implementation of the home’s medication procedures. Medication Administration Records (MAR) were completed, and all medication received into the home was recorded, and a locked trolley used for administration rounds. Controlled drugs are double locked in a specific cupboard and all controlled drugs are recorded in a separate book. They are then signed for by two members of staff when administered. All staff have had training in administration of medication from Swindon College, with some new staff still to do this. We watched a medication administration round, where one member of staff was giving out medication to residents. When medication is being dispensed, the correct procedure is to give the medicine to the resident, observe them taking it and then to sign the Medication Administration Record (MAR) to say that this has been done. On this occasion, the staff member concerned took medication in a pot to the table and left it for a resident. She then turned her back, without waiting to see that the medication had been taken. She went on to help another resident with her food. She did not return to sign the MAR, and when we looked at the record, it had been signed prior to giving the medication. When asked why this was done, the staff member said she did not know why she did that – it was quicker. She said that she knew that the resident “always took” her medication. However, she admitted that in fact medication could be dropped, or even taken by another resident when left lying. The providers were informed of this serious breach immediately, and were going to deal with the matter there and then. The providers have been reminded that staff must sign the MAR only when they have seen the medication taken. All residents spoken with confirmed satisfaction with staff members, and families said that they were happy with the way their relatives were treated. Staff were observed knocking on doors and residents were spoken to with their preferred form of address. Staff induction training makes it clear that the home’s expectation is that residents will be treated with dignity, and that their independence and self esteem must be encouraged. Two residents have a mobile phone and some have phones in their rooms, so they can contact friends and relatives in private. Bluebell Lodge practices a non-discriminatory policy with regards to race, religion and gender both for staff and residents. One GP who wrote to us recently said that the care service “usually” respected individuals’ privacy and dignity. Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Activities for residents have increased with the advent of a new staff member. People can have as much or as little contact with family and friends as they wish, and are supported to do so by staff. Residents are encouraged to follow their preferred routines and make their own choices. They receive a wholesome, appealing, balanced diet. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents spoken to reported that they are able to follow their preferred routines and choose how they spend their day. Residents are therefore able to get up and go to bed at preferred times and spend time in their room as required. Some residents spend a great deal of time in their room, and have solitary interests such as reading, crosswords and television. Staff discuss individual residents’ religious preferences, and arrange for church services and visits from local vicars or priests. Residents can have the services of a visiting minister or are supported to attend church. Some residents attend the local stroke club. Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 15 The home has employed a part time activities worker who has spent time getting to know residents’ likes and dislikes and is therefore able to base any activities around individual people. She has many contacts and has arranged visits and talks for residents, as well as arranging for a mobile library to visit. People’s interests have been recorded and catered for inside and outside the house. There has been a talk from someone about Lacock Abbey, and a trip is being organised to visit the gardens there. She also visits people who spend time in their own room, and has given some people a hand massage. She has set up activities for individuals and groups to take part in. One resident likes poetry and being read to. Another is very interested in horticulture and showed us various plants in the garden. One relative said recently: “I made the comment last year that the residents would benefit from communal activities. This has been implemented with soft ball games, quizzes and various outings. Bluebell Lodge listened and acted”! Residents can entertain family or friends either in the privacy of their own bedrooms or in the communal areas available. Staff encourage and support links between residents and their families, although the frequency of contact varies depending on individual circumstances. Some family members keep in touch with regular phone calls. One relative spoken to recently said: “Mum’s very happy here, so if she’s happy, we’re happy”. Residents can bring some of their own possessions to the home when they move in, and many of the rooms contained personal items and small pieces of furniture. One relative recently said: “My cousin seems very happy there, which tells me there are no rigid restrictions”. Bluebell Lodge recently employed a chef to cater for residents meals. Unfortunately he has been absent recently, so care staff have been cooking for residents. Residents said that they mainly enjoyed the food, and enjoyed having a choice if there was something on the menu they didn’t want or like. Drinks are offered to residents throughout the day. Some people have to have soft food and others need to follow a diabetic diet. These are well catered for at Bluebell Lodge. Food charts are in place so that a record can be kept of what residents have eaten. Some residents eat in the dining room, although others prefer to eat in their room. Lunch on the day of the inspection was sausages or fish, chipped or mashed potatoes and peas and carrots. Pudding was yoghurt or crème caramel. Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Residents and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. The policies and procedures which the home has in place ensure that residents are protected from abuse. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure in place, and this is given to service users and their families. There is a complaints log in place, and one complaint had been received recently. This was dealt with promptly by the providers. There have been no complaints about the home received by CSCI. All of the residents spoken with said that they were happy living in Bluebell Lodge, and when asked, said that they would take any concerns they might have to the staff. One resident said: “I would talk to the owners”. The home has copies of the “No Secrets” document, as well as the organisational policy and procedure on responding to allegations of abuse. All staff members are encouraged to report any incidences of poor practice, and a “Whistle Blowing” procedure is available. All staff have had training in Safeguarding Adults, and have received certificates to evidence this. There has been one appropriate referral made to the vulnerable adults unit. Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 17 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 Residents live in a well maintained, mainly safe environment. They live in homely, clean, pleasant and hygienic surroundings. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Bluebell Lodge is a very comfortably furnished home with large airy rooms. Residents’ bedrooms were homely and each contained individual personal items. Radiator covers are in place for most radiators, with only a few left to do. Risk assessments are in place for those which are waiting to be fitted. There is a large, secluded garden to the side and rear of the house, with ample parking to the front of the home. A great deal of work has been done by the provider in refurbishing the home. Gates are being fitted at the front of house, and a patio has been built at the back. A ramp has been built from the french doors of the quiet lounge in order Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 18 to make access into the garden easier for residents, and handrails have been fitted. All fire exit doors are now alarmed and there is a new keypad system at the front door to help keep people safe. Keypads have now been fitted to the boiler room and the laundr room. New furniture has been purchased for the lounge, and this room has been decorated. Bedrooms are decorated as residents leave. New electronic door guards have been fitted on internal doors. When we arrived one of these was malfunctioning. Staff called the firm who came out that same day to repair it. Bluebell Lodge has a laundry room with two washing machines, one of which is a large, large, industrial style. There are two tumble dryers. The equipment and practices for handling laundry are suitable for reducing the risks from any items which may be soiled or infected. The kitchen and food storage areas were seen to be clean and hygienic. The home’s infection control policy is discussed with new members of staff at induction, and all other staff have had infection control training. Hand gel has been placed throughout the home for staff, residents and visitors to use. The residents’ upstairs bathroom had single use soap although paper towels were on the shelf, not in a dispenser, which means it is possible to contaminate the towel(s) below. It is recommended that a dispenser is used. A cleaner has been employed, and both she and the staff are to be congratulated in their determination to ensure that the home is kept clean and tidy. A cleaning rota has been devised, and a checklist is completed every day. The cleaner told us that she would like to develop this rota even further, so that she had a more explicit recorded routine, which specifies which rooms are done and when. One relative said to us recently: “The home is always clean and tidy and always smells fresh”. Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 19 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 The home has the number and skill mix of staff to meet residents’ care needs. They are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their job, which means that residents are in good hands. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Bluebell Lodge has three staff members on duty during the day and two waking night staff. The home’s chef and handyman were both absent, but the addition of a part time administrator, a cleaner and an activities co-ordinator has greatly improved the staff team. There are two senior carers who take responsibility for more junior staff. There were a total of ten staff with an NVQ level 2 or above, including one senior carer who has an NVQ level 4 in Health and Social Care. Residents spoke very highly of the care staff. One person said she was “very satisfied” with the home and the staff, adding that they had all been very helpful since she had arrived. Another said: “They’re all very good to me”. Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 20 Bluebell Lodge’s recruitment procedures should include Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks, two written references and a medical declaration. All potential staff complete an application form, and this is kept by the home. This has previously been an area of weakness, but all files examined now contained the required documentation. There was one file where the application form was not fully completed, with some dates being ommitted. There was no record of the person being questioned about this at interview. The providers have been reminded that all potential staff must be questioned about gaps in their employment record. This is so that they can be sure that residents are supported by people who are fit to do so. Bluebell Lodge has recently provided training courses for staff in several areas. This includes infection control, fire awareness, manual handling, medication, use of the hoist, health and safety, first aid and food hygiene. It is planned to offer staff training on the Mental Capacity Act in the future. The training issues identified at the last two inspections have all been dealt with. Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Residents live in a home which is currently run and managed by the providers. Their opinions are being sought as to how the home should best be run, although the introduction of a formal quality assurance system would support this. Residents’ financial interests are safeguarded. Staff are appropriately supervised, and the health, safety and welfare of residents and staff are promoted and protected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection, the manager has been refused registration and the providers have been managing the day to day business of the home. A great improvement can be seen in many areas, including training, care planning and Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 22 risk assessments and staff supervision. A new manager has been appointed who has had several years experience of managing a care home, and is due to start in post very soon. The providers have completed an Annual Quality Assurance Assessment for us. Different types of questionnaires have been developed which will be given to residents, relatives and other professionals. This will give people a chance to air their views about how the home is run. The results of these surveys will be collated feedback will be given to those who responded. Consideration should be given to using an independent advocacy service to help with this. There is no structures quality assurance system used by the owners. In discussion, they said that they were still investigating different systems, and that they would introduce one imminently. They have been asked to ensure that this is done. Large amounts of money, including the home’s fees, are normally managed by residents themselves or by their families or their solicitor. A small amount of money is kept by the home for those residents who cannot manage their own affairs. This is to allow for small, personal items of expenditure, such as hairdressing. This money is kept in a locked box in the office and each item paid for is recorded in a ledger. This is then available to show any family member or solicitor who reqests it. The records were in good order. The money held for two of the residents was checked, and both were correctly balanced. Staff supervision files were examined. One person had no records on file of any supervision, but was still going through her induction period, and supervision was planned for the end of that. Another file showed that the staff member had had regular two-monthly supervision sessions. This had been outstanding for several inspections, and has now been dealt with. The home has detailed health and safety policies and procedures in place. One staff member takes responsibility for fire safety procedures, and provides training for the rest of the staff. A series of daily, weekly and monthly checks should be done. At the previous inspection, it was noted that the boiler room door was able to be opened and constituted a potential risk to residents. This door was now locked with a key-coded entry system. The fire risk assessment was not able to be found during the inspection, but was later sent to us to have a look at. This had been completed in October, and had been done by an external consultant. Fire extinguishers had been checked in January 2008. Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 23 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 1 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 24 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 4 (1) (c ) Schedule 1 Requirement The Statement of Purpose must be amended to include details of staffing and management qualifications and experience as well as the home’s complaints procedure, fire procedures and fee structure. Timescale for action 16/07/08 2 OP3 Comment: This is the second time this requirement has been made. However, work on it is underway. 13 (4) (c ) Where assessment information indicates a resident is at risk of pressure sores a risk assessment must be put into place to show how the home will manage the situation. Comment: This is the second time this requirement has been made. All care plans must be reviewed on a regular basis or when a change in circumstances indicates this. Comment: This is the second time this requirement has been made. 16/07/08 3 OP7 15 (2) (b) 16/07/08 Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 25 3 OP8 4 OP8 5 6 OP8 OP9 7 OP29 Where fluid charts are used, the daily amount of fluid taken must be tallied up. Professional advice must be sought about how much fluid is needed by each individual. 13 (4) (c) People with mobility difficulties must have risk assessments which highlight the risk to all pressure areas. 18 (1) (c ) Staff must have training in how (i) to use all oxygen equipment. 13 (2) Staff must sign the Medication Administration Record only when they have seen the medication taken. 19(4,b,i), All potential staff must be S(2,6) questioned about gaps in their employment record. Comment: This is the second time this requirement has been made. A system must be established which evaluates the quality of the services provided at the care home. 13 (1) (b) 16/07/08 16/07/08 16/07/08 16/07/08 16/07/08 8 OP33 24 (1) 16/07/08 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 OP3 OP8 OP26 Good Practice Recommendations Where scoring systems of assessment are used, these should explain clearly how the rating is reached and what must be done at this stage. Suitable weighing scales should be used so that people who cannot weight bear can still have their weight recorded. Dispensers should be used for paper towels so that they are not left lying on a shelf where they can become contaminated. DS0000040675.V361825.R01.S.doc Version 5.2 Page 26 Bluebell Lodge Care Home 4 OP33 Consideration should be given to the use of an independent advocacy service to help get feedback from the residents about the quality of the service provided. This should be part of the home’s internal quality assurance to assess where it might improve according to the opinions of its residents. Bluebell Lodge Care Home DS0000040675.V361825.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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