Inspection on 26/11/07 for Bluebell Lodge Care Home

This inspection was carried out on 26th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bluebell Lodge Care Home 15/05/08

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 10:30 26 and 28 November 2007 th th 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.V344514.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.V344514.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.V344514.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. 7th February 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. A copy of the service users’ guide is given to all new residents. Those residents who are funded by the local authority top up the fees to £370 pounds per week. Fees vary from £480 per week to £525 per week for respite care. Additional charges are made for hairdressing, and various other sundry goods. Bluebell Lodge Care Home DS0000040675.V344514.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day in February. Several residents and members of staff were spoken to, as well as the cook and the manager. Various documents and files were examined, including care plans, health & safety procedures, risk assessments, medication procedures and staff training files. Seven family members and one general practitioner (GP) responded in writing to our questionnaires, as well as one resident who was supported in doing this by a relative. After an inspection last year, it was felt that the service was sufficiently underperforming enough to ask them for an improvement plan. This was so that they could show us how they planned to make things better. The manager showed us various improvements she planned to make which would mean that residents would have a better quality of life. Unfortunately, it was found at this inspection that she had failed to implement some of these improvements. There were a number of areas of concern noted, and it was felt necessary to return for a second day. As a result of these visits, an Immediate Requirements Letter was sent to the provider, outlining the most serious failings, and those which posed a threat to service users, and asking them to respond within seven days. 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. 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. One relative said: “My mother is always well looked after, with good food. Her washing is done every day if needed, and everything is clean and tidy”. There have been many improvements made to the fabric of the house, both internally and externally. New furniture has been purchased for the lounge, and this room is to be decorated for Christmas. Bedrooms are decorated as residents leave, and new electronic door guards have been fitted on internal doors. Gates are being fitted at the front of house, and a patio has been built at the back. A ramp is being built from the french doors of the quiet lounge in order to make access into the garden easier for residents. All fire exit doors Bluebell Lodge Care Home DS0000040675.V344514.R01.S.doc Version 5.2 Page 6 are now alarmed and there is a new keypad system at the front door to help keep people safe. What has improved since the last inspection? What they could do better: A great deal of work has been done by staff to try to improve procedures in many areas. However, there are still serious shortfalls in how the home has been managed. The registered manager has been negligent in implementing the home’s recruitment procedures. It is also disappointing to note that, in spite of an improvement plan which had been developed last year, many of the same problems were still in evidence. There were some areas of such immediate concern that a letter was sent to the providers immediately after the inspection. These related to the health and safety of residents, and included vulnerable people being at risk. The manager has supplied an action plan in relation to these issues, and they will be monitored on a continuing basis. Assessments, care plans, personal and physical care and risk assessments are some of the areas causing concern. Staff training, lack of implementation of fire procedures, recruitment procedures, training and supervision are among the others. The registered provider has been told to ensure that these areas are improved and the expectation will be that this improvement will be sustained. The Statement of Purpose contained many pieces of information which had been taken from the National Minimum Standards, (NMS), and as such were more generic rather than specific to the home. The expectation of the Commission for Social Care Inspection (CSCI) is that care home providers will compile their own Statement of Purpose rather that plagiarise the NMS. The provider has been told to ensure that the home’s Statement of Purpose contains information relating to the qualifications and experience of the Bluebell Lodge Care Home DS0000040675.V344514.R01.S.doc Version 5.2 Page 7 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. The Service User Guide contained photographs of ex-residents and staff, and these should be removed. Written permission should be sought from current residents and staff for the use of their photographs before the final document is handed out to residents or their families. 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.V344514.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.V344514.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 not assessed and recorded before they move in to the home. Quality in this outcome area is poor. 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 available, and had been revised in June 2007. The Statement of Purpose contained many pieces of information which had been taken from the National Minimum Standards, (NMS), and as such were more generic rather than specific to the home. The expectation of the Commission for Social Care Inspection (CSCI) is that care home providers will compile their own Statement of Purpose rather that plagiarise the NMS. The provider has been asked 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 Bluebell Lodge Care Home DS0000040675.V344514.R01.S.doc Version 5.2 Page 10 should outline the staffing structure and give details of the home’s complaints and fire procedures. The Service User Guide contained photographs of exresidents and staff, and these should be removed. Written permission should be sought from current residents and staff for the use of their photographs before the final document is handed out to residents or their families. The manager usually meets with any prospective resident and family as part of the assessment process and collects various pieces of information regarding their needs. The file for one new resident was examined, and although the manager had not personally assessed the person, the latest community care assessment was on file, as well as a nursing assessment from a stay in hospital. This person had been recorded on the assessment to be “at risk of pressure sores”. However, there were no risk assessments in place which would show how the home would manage this problem, 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. One safety assessment highlighted “use of appliance” but failed to mention that the person used a walking frame. New residents were not weighed routinely on admission, making it difficult in the future to assess any weight loss or gain. It is recommended that all residents should be weighed on admission to the home in order to note any varience at a later date. During the collection of assessment information, various forms were used, including some which used a scoring system. This proved to be confusing, as some scores were counted and some were not. Those scores counted showed no link to what the score actually meant and no action was planned as a result of any score. For example, one person was scored as 3 for the section which means “below par” and 3 for the section which means “unsatisfactory”. The initial assessment system should be developed to link to the headings which form part of the residents’ care plans. There are no intermediate care beds in Bluebell Lodge. Bluebell Lodge Care Home DS0000040675.V344514.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 do not all have all their health, personal and social care needs set out in care plans. Their health needs are not fully met. Residents are mainly protected by the home’s medication policies and procedures. They feel they are treated with respect and their right to privacy is upheld. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident in Bluebell Lodge has their own care plan. Information on care plans includes sleep routines, eating, communication, mobility and personal care needs. Whilst talking to staff, it was clear that they were aware of individual’s needs. One person in the home was recorded as being verbally aggressive to staff and has tried to bite carers and kick out. This assessment was dated September 2006 and had not been reviewed. Another resident was said by the manager to have displayed sexually inappropriate behaviour. There were no risk Bluebell Lodge Care Home DS0000040675.V344514.R01.S.doc Version 5.2 Page 12 assessments on file which showed how staff would manage these behaviours. All residents who have shown challenging behaviours must have a risk assessment in place. These must clearly demonstrate to staff how these behaviours are to be managed. We wrote immediately to the providers telling them to make sure this was done for these particular residents. Two residents with severe mobility problems are in bed all day. There were no risk assessments in place regarding moving and handling. One resident had a risk assesment in place relating to falls. This said that the bed had cotsides but that there was a need for a hospital bed. This was dated April 2007 and had not been reviewed. The manager said that this had been done, but that the paperwork just didn’t show it. She has been asked to ensure that all risk assessments are reviewed on a regular basis or when a change in circumstances indicates this. All residents who need support with mobility must have a moving and handling risk assessment in place. We wrote immediately to the providers telling them to make sure this was done for these particular residents. The two residents who are cared for in bed were described as having their food liquidised and are supported with feeding as they are unable to do so by themselves. There were no nutritional risk assessments in place to show how the home managed their dietary intake, although the chef said he took great care with their food. The manager has been asked to ensure that all all residents with mobility needs have a nutritional risk assessment. We wrote immediately to the providers telling them to make sure this was done for these particular residents. One resident in the home was described by Mrs Jenkins as having a pressure sore on one foot. The form entitled “Physical health” describes the toes on the left foot variously as “very red” and “black”. The form said “ Keep a close check”. A body chart was on file, but dated 4/06/07. There was no sign of any review. There was no care plan which outlined how this pressure sore is managed. All residents who have pressure care needs must have a care plan which outlines the management of the pressure sore and any treatment associated with this. All care plans must be reviewed on a regular basis or when a change in circumstances indicates this. We wrote immediately to the providers telling them to make sure this was done for the particular resident. One resident had been due to see a physiotherapist in June, but there was no record of this, or any other, appointment being made or kept, although the manager again said that appointments had been made. She has been asked to keep records of all medical appointments for residents. This same resident had been discharged from hospital and the medical summary contained information about various conditions, some of which had been recorded in the form of initials. Mrs Jenkins had repeated these on to the Bluebell Lodge assessment Bluebell Lodge Care Home DS0000040675.V344514.R01.S.doc Version 5.2 Page 13 information forms. When asked if she knew what the initials meant, she said she did not. When asked if she had sought medical advice about this she replied that she had not. This means that the resident is being cared for by staff who are not fully aware of his condition. The manager was asked to ensure that where medical conditions are not understood, medical advice is urgently sought. We wrote immediately to the providers telling them to make sure this was done for the particular resident. There were body charts in place for residents which reflected the area where there were pressure sores. However, there was one with several marks on the chart which indicated pressure areas. The manager explained that these were areas which might become affected. It is recommended that where body charts are kept these should record only the site of actual pressure sores. The two residents who are cared for in bed are said to need two hourly turns to help prevent pressure sores. This is recorded on a sheet of paper kept in their rooms. However, one turning chart had not been completed since 23rd November, three days before the inspection. The manager was sure that it had been done and that staff had just forgotten to complete the chart. It is recommended that where turning charts are kept for residents with pressure area problems, these should be fully documented. 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. One resident had been prescribed medication. When asked why this was prescribed Mrs Jenkins did not know. When asked if she had sought medical advice about this she replied that she had not. This means that the resident is being cared for by staff who do not know why he is taking some medication. The manager was asked to ensure that where medication is prescribed for a resident, and the reason for this is unknown, medical advice is urgently sought. We wrote immediately to the providers telling them to make sure this was done for the particular resident. Usually any stock left over goes back to pharmacy, but this had not been done on this occasion. New stock had arrived, and one box had been opened. On checking this it was difficult to establish just how many tablets should have Bluebell Lodge Care Home DS0000040675.V344514.R01.S.doc Version 5.2 Page 14 been left. It is recommended that the date on which a box of medication is opened should be recorded in order to help staff with stock checking. 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. The GP who wrote to us said that the care service “usually” respected individuals’ privacy and dignity. Bluebell Lodge Care Home DS0000040675.V344514.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 Activities for residents within the home are limited, although this is likely to improve 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.V344514.R01.S.doc Version 5.2 Page 16 The home has employed a part time activities worker who will spend time getting to know residents’ likes and dislikes and will therefore be able to base any activities around individual people. She has many contacts and is arranging visits and talks for residents, as well as arranging for a mobile library to visit. She was about to research books on Vienna and Art for one resident who used to be an artist, and was going to get some talking books from the library. Some residents were plaing draughts and snakes and ladders, and some had made Christmas cards. She is planning to use a questionnaire to find if people like to do things in the sitting room or in their bedroom. One relative wrote: “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. All seven relatives who replied to our questionnaire said that they were consulted about their relative’s care if the individual concerned was not able to make decisions. One relative who was visiting the home 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 said: “My cousin seems very happy there, which tells me there are no rigid restrictions”. The home has now employed a cook five days a week. In conversation with the chef, he described how he separated out food for liquidised diets, and did not put all the foodstuffs together. Staff support those residents who need help with feeding. He has devised a fortnightly menu, and orders the food from the internet. This is then delivered to the home. Lunch on the first day of inspection was chicken and vegetable pie with carrots, broccoli and potatoes with chocolate gateau to follow. Lunch on the second day was roast chicken, although two people who didn’t want it were offered alternatives. Tea and coffee were offered throughout the day, and there was fresh fruit in a bowl on the dining table for people to eat. A food ledger records ”didn’t eat well today” or “had a small lunch today”. The menu, the shopping list and the food ledger are seen by the home as a good way of tracking back what residents eat. Some residents who had mobility needs did not have a nutritional risk assessment in place, and the manager has been told to do this. (See Standard 8 above) Bluebell Lodge Care Home DS0000040675.V344514.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 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 by the manager, and related to one resident feeling cold since new door guards had been fitted and doors were open more. The complaint was resolved by the manager asking the family to bring in new winter clothes rather than summer ones. However, there was no evidence of seeking advice in relation to this resident to see if there was any underlying medical condition, and no obvious discussion about the resident’s preference of housewear. There have been no recent complaints received by CSCI. The resident and five of the seven relatives who wrote to us, all said they knew how to make a complaint, although two people said they did not. One said: “We have not had cause to complain”. The home has copies of the “No Secrets” document, as well as the organisational policy and procedure on responding to allegations of abuse. All Bluebell Lodge Care Home DS0000040675.V344514.R01.S.doc Version 5.2 Page 18 staff members are encouraged to report any incidences of poor practice, and a “Whistle Blowing” procedure is available. All staff have had training in Vulnerable Adults procedures, and have received certificates to evidence this. There have been no referrals made to the vulnerable adults unit. Bluebell Lodge Care Home DS0000040675.V344514.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 Residents live in a well maintained, mainly safe environment. They have the specialist equipment they need, although staff have not been trained in how to use it. 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 Bluebell Lodge Care Home DS0000040675.V344514.R01.S.doc Version 5.2 Page 20 back. A ramp is being built from the french doors of the quiet lounge in order to make access into the garden easier for residents. All fire exit doors are now alarmed and there is a new keypad system at the front door to help keep people safe. New electronic door guards have been fitted on internal doors. New furniture has been purchased for the lounge, and this room is to be decorated for Christmas. Bedrooms are decorated as residents leave. The boiler room opposite the shower room is used by the handyman and has tools inside, including an electric drill. There is no lock on this door, and the manager has been asked to ensure that one is fitted so that any resident who tries to open the door will be safe. The home has a variety of hoists and belts in use, and the manger described another type of standing hoist she wanted to buy. There was no evidence on file of any staff training in the use of these belts or the hoist in use, and the manager has been asked to ensure that this is done. 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. Staff are doing infection control training. 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. The resident who wrote to us said that the house was always fresh and clean, and one relative wrote to say: “The home is always clean and tidy and always smells fresh”. Bluebell Lodge Care Home DS0000040675.V344514.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 The home has the number and skill mix of staff to meet residents’ care needs. Serious shortfalls within the recruitment procedures, despite being identified at previous inspections, place residents’ at risk of poor care practice and abuse. Residents are not supported by staff who have had all the training they need to support them. Quality in this outcome area is poor. 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 also has employed a chef five days per week and, more recently, an activities co-ordinator, as well as a part time cleaner and a handyman. The manager is supported by a part time administrator. There are two senior carers who take responsibility for more junior staff. In the past, care staff were responsible for cooking and cleaning, and the employment of ancillary staff has freed them up to spend more time with residents. When asked if the care staff have the right skills and experience to support individuals’ social and health care needs, the GP who wrote to us said that this “can vary”. One family member said that staff were “very kind and considerate” to their relative. “Nothing is too much trouble for them”. Bluebell Lodge Care Home DS0000040675.V344514.R01.S.doc Version 5.2 Page 22 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. There were staff files where there were gaps in the details of previous employment, but no record of people being questioned about this. One staff member had not completed the section about previous employment at all. Previous inspections noted that the recruitment procedure within the home was poor and needed greater attention to ensure protection. During this inspection, two staff files examined showed that this was still the case. Two staff members had been employed before their CRB check had been verified. One person was employed a month before the CRB was obtained, and the other had none at all on file. This person’s file contained only one written reference, and that had come in on the morning of the inspection. In discussion with the manager, Mrs Christine Jenkins, she admitted that she had started these staff members without first obtaining a CRB or POVAFirst check. When questioned as to why she did this, she said she had felt sure that the people were trustworthy. One of the people concerned was known to her as the daughter of a current staff member, and the other was recruited as an activities co-ordinator. We discussed the POVAFirst system, and she agreed that she had not tried to get this done for the two staff members involved. Mrs Jenkins was reminded about her responsibility to ensure that residents in her care are protected by robust recruitment practices. We wrote immediately to the providers telling them to make sure a check is done for the individual staff member. There were a total of eleven staff with an NVQ level 2 or above, including one senior carer who has an NVQ level 4 in Health and Social Care. Of the four staff files examined there was evidence of training in dementia awareness, health and safety, Protection of Vulnerable Adults and food hygiene as well as fire training/fire awareness. Some files did not have evidence of induction training and none showed any evidence of any manual handling training, in spite of the fact that several of the home’s residents are frail and need support with their mobility. New staff had no evidence of any medication training, although the senior carer reported that they wouldn’t be allowed to administer medication for some time after starting work, and that they would have to ”shadow” more experienced workers. The manager has been asked to ensure that these training issues are addressed. Bluebell Lodge Care Home DS0000040675.V344514.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Service users live in a home which is run and managed by a person who is yet to be registered with the CSCI and has deliberately put residents at risk by poor recruitment practices. Failure to ask for their opinions means that the home is not run in the best interest of residents. Their financial interests are safeguarded. Staff are not appropriately supervised, and the health, safety and welfare of residents and staff are not promoted and protected. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home, Mrs Christine Jenkins, has been in post since June 2006, although she is not yet registered with the Commission for Social Care Inspection (CSCI). There have been several occasions where Mrs Jenkins’ application form has had to be returned because of her failure to include Bluebell Lodge Care Home DS0000040675.V344514.R01.S.doc Version 5.2 Page 24 documentation. Although Mrs Jenkins is aware that there were concerns previously about the home’s performance, and completed a formal improvement plan last year indication how she would improve manual handling and induction training, care plans and risk assessments, there is evidence that these areas have not improved. Mrs Jenkins was aware of the need to have disciplinary measures in place. However, on examination of one staff file it was noted that the disciplinary procedure held for one carer was attended by the staff member involved and another carer. When questioned about this, Mrs Jenkins said that this person had attended as a witness for her, as no senior staff members were available. She showed no understanding that it was inappropriate to use a colleague of the carer being disciplined on her own behalf. Mrs Jenkins admission that she had knowingly employed staff without the requisite CRB and POVA checks is a serious matter and the CSCI will be taking this into consideration when evaluating her registration application. There is no formal mechanism in place to verify that the home is run in the best interests of the residents. The manager visits all areas of the home and speaks to residents every day, which helps to foster good relationships. However, there has been no formal consultation with residents about what they like about Bluebell Lodge and what could be improved, although families’ views have been sought. The benefits of doing this were discussed with Mrs Jenkins at the last inspection, and she has once again been asked to ensure that a questionnaire is developed which will give people a chance to air their views. Consideration should be given to using an independent advocacy service to help with this. As part of their regulatory duties, the provider must visit the home and produce a report of his visit at least once a month. This is currently done, although the report is usually of an extremely brief nature. The registered provider should give more detail in the reports of his visits to the home. He should consider using the format provided by CSCI . 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 mainly in good order. The money held for two of the residents was checked. One person’s records were correctly balanced, although there was an entry for a chiropody appointment which had not been dated. It is recommended that the date of any expenditure on behalf of residents should Bluebell Lodge Care Home DS0000040675.V344514.R01.S.doc Version 5.2 Page 25 be recorded. Another person’s records showed that £15 had been found in an envelope in her purse. There was no record of how this had got there or who had put it there. It is recommended that all staff should complete a record when they add money to residents’ belongings. There were few records of staff supervision on file. Of four staff files examined two had only one session in 2007 and the other two had none. This was made a requirement at the previous inspection. The manager has once again been asked to ensure that formal, recorded supervision sessions take place regularly. It is also recommended that the manager is supported by the provider in the same way, and receives formal, recorded supervision. 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. The means of escape should be checked monthly, although it was last done in September. The fire alarm testing is meant to be done weekly although it had not been done since August. In discussion with Mrs Jenkins she said that the staff member involved “must have forgotten a couple of times”. The manager has been asked to make sure that all health and safety and fire checks are done according to the home’s own procedures. One of the staff members who has started work in February 2007 had no evidence on file of any fire training, and the manager has been asked to make sure that all staff have evidence that they have had this training. Bluebell Lodge Care Home DS0000040675.V344514.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 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 2 17 X 18 3 2 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 X 1 Bluebell Lodge Care Home DS0000040675.V344514.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 (1) (c ) Schedule 1 Requirement Timescale for action 28/02/08 2 OP3 13 (4) 3 OP7 12 (1) 13 (4) 4 OP7 15 (2) 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. (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. (a) All residents who have pressure (c) care needs must have a care plan which outlines the management of the pressure sore and any treatment associated with this. Comment: We wrote immediately to the providers telling them to make sure this was done. It was also carried forward from the last inspection. (b) All care plans must be reviewed on a regular basis or when a change in circumstances indicates this. DS0000040675.V344514.R01.S.doc 05/12/07 05/12/07 28/12/07 Bluebell Lodge Care Home Version 5.2 Page 28 5 OP7 6 OP7 7 OP7 8 OP7 9 OP8 10 11 OP8 OP8 Comment: We wrote immediately to the providers telling them to make sure this was done. It was also carried forward from the last inspection. 13 (4) © All residents who have shown challenging behaviours must have a risk assessment in place. These must clearly demonstrate to staff how these behaviours are to be managed. Comment: We wrote immediately to the providers telling them to make sure this was done. 13 (4) (c ) All residents with mobility needs must have a nutritional risk assessment and a pressure care risk assessment completed. Comment: We wrote immediately to the providers telling them to make sure this was done. 13 (4) (c ) All residents who need support with mobility must have a moving and handling risk assessment in place 15 (2) (b) All risk assessments must be reviewed on a regular basis or when a change in circumstances indicates this. Comment: This requirement has been carried forward from the last inspection. 12 (1) (a) When body charts are kept for resident with pressure area problems, these must be reviewed on a regular basis. 13 (1) (a) Records must be kept of all medical appointments for residents. 13 (1) (b) Where a medical condition is recorded in abbreviated form and the meaning is not known, medical advice must be urgently sought. DS0000040675.V344514.R01.S.doc 05/12/07 12/12/07 12/01/08 12/01/08 12/01/08 12/01/08 05/12/07 Bluebell Lodge Care Home Version 5.2 Page 29 12 OP8 13 14 OP8 OP9 15 OP19 16 17 OP22 OP29 Where turning charts are used to support residents’ pressure care, these must be fully documented. Comment: This requirement has been carried forward from the last inspection. 17 All serious incidents relating to residents health must be reported to CSCI. 13 (1) (b) Where medication is prescribed for a resident, and the reason for this is unknown, medical advice must be urgently sought. Comment: We wrote immediately to the providers telling them to make sure this was done. 13 (4) (a) The door of the boiler boiler room must have an external lock fitted in order to prevent residents entering it. 18 (1) (c ) All staff must have evidence of (i) training in how to use the hoist. 19 (1) (b) All members of staff must have (i) two satisfactory references, a Schedule CRB and a POVA check or a 2 POVAFirst check in place before starting work in the home. Comment: We wrote immediately to the providers telling them to make sure this was done. It has also been carried forward from previous inspections. All potential staff must be questioned about gaps in their employment record. All new staff must have evidence of induction training on file. Comment: This requirement has been carried forward from previous inspections. All staff must have manual handling training. Comment: This requirement has been carried forward from the last inspection. DS0000040675.V344514.R01.S.doc 12 (1) (a) 12/01/08 12/01/08 05/12/07 28/12/07 28/01/08 28/11/07 18 19 OP29 OP30 19(4,b,i), S(2,6) 18 (1) (c) (i) 28/11/07 28/12/07 20 OP30 18 (1) (c) (i) 28/02/08 Bluebell Lodge Care Home Version 5.2 Page 30 21 22 OP30 OP36 18 (1) (c) (i) 18 (2) 23 24 OP38 OP38 23 (4) (d) 13 (4) (a) (c) All staff must have medication training. All staff must have regular one to one supervision with their line manager. Comment: This requirement has been carried forward from the last and previous inspections. All staff must have evidence of fire training. All health and safety and fire checks must be done according to the home’s own procedures. 28/01/08 28/02/08 28/01/08 28/01/08 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 Refer to Standard OP1 Good Practice Recommendations The Service User Guide should not contain photographs of ex-residents or staff, and written permission should be sought from current residents and staff for the use of their photographs before the final document is handed out to residents or their families. All residents should be weighed on admission to the home in order to note any varience at a later date. The initial assessment system should be developed to link to the headings which form part of the residents’ care plans. Where body charts are kept these should record only the site of actual pressure sores. The date on which a box of medication is opened should be recorded in order to help staff with stock checking. The registered provider should give more detail in the reports of his visits to the home. He should consider using the format provided by CSCI . The registered provider should seek external views about the running of the home. 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. DS0000040675.V344514.R01.S.doc Version 5.2 Page 31 2 3 4 5 6 7 8 OP3 OP3 OP8 OP9 OP33 OP33 OP33 Bluebell Lodge Care Home 9 10 11 OP35 OP35 OP36 This should be part of the home’s internal quality assurance to assess where it might improve according to the opinions of its residents. The date of any expenditure on behalf of residents should be recorded. All staff should complete a record when they add money to residents’ belongings. The manager should be supported by the provider and receive formal, recorded supervision. Bluebell Lodge Care Home DS0000040675.V344514.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Regional Office 4th Floor, 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. Extracts may not be used or reproduced without the express permission of CSCI Bluebell Lodge Care Home DS0000040675.V344514.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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