Inspection on 07/02/07 for Bluebell Lodge Care Home

This inspection was carried out on 7th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bluebell Lodge Care Home 15/05/08

Bluebell Lodge Care Home 26/11/07

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 7th February 2007 12:00 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.V329402.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.V329402.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 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.V329402.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 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. 29th June 2006 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 16 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. Fees vary from £1404 per month to £1950 per month. The fee is £480 per week for respite care. Additional charges are made for hairdressing, although the home provides residents with toiletries. Bluebell Lodge Care Home DS0000040675.V329402.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 (as yet) unregistered manager. Various documents and files were examined, including care plans, health & safety procedures, risk assessments, medication procedures and staff training files. Five residents, four family members and two general practitioners (GP) responded in writing to our questionnaires. This key inspection was made as a result of a previous inspection where the outcome had been assessed as “poor” for service users. The home was asked to provide an action plan as a result of that inspection. The home’s owners, the (as yet) unregistered manager and staff have all worked hard to make an improvement, and should be congratulated for their efforts. 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 spoke highly of the staff and the providers, saying that they were very well looked after. One relative said; “Staff give exceptional support to the residents”. 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 General Practitioner (GP) who wrote to us said; “There have been considerable improvements in the last twelve months. The staff are more motivated and interested in patient care and I feel provide outstanding care and attention for some difficult patients”. Residents said that the food is very good. The menu is varied, and provides a choice at breakfast and at teatime, with the option of a cooked breakfast at weekends. The main meal of the day is at lunchtime. One resident said; “We have a very good Sunday roast and all meals are cooked fresh. Lots of fresh vegetables and meals kept to low fat requirements”. Bluebell Lodge also caters for people who have to have special Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 6 diets including those with diabetes. Residents can eat together in the dining room but some said that they can have their meals on a tray in their room if they want to. What has improved since the last inspection? What they could do better: Some residents were being cared for in bed and were using bedrails and grab rails beside the bed. There were no risk assessments in place for the people using these pieces of equipment, and nothing on file to say that the equipment had been assessed professionally as being appropriate for the residents use. Recent guidance has shown that residents could be at risk of being trapped by Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 7 these rails if they are not the correct type for the bed. The manager has been asked to make sure that reviews are sought regarding the use of bed rails for all those people who use them, and to ensure that risk assessments are in place regarding their use. The people who were being cared for in bed were turned in bed every two hours so that there was less risk of them developing pressure sores. They also had their fluid intake monitored in order to make sure that they were drinking enough. The staff are to be congratulated on the fact that the residents had no pressure sores at all on their skins. However, there were no recent records of these residents being turned and no records of fluids being offered. The manager has been asked to make sure that both of these things are recorded and monitored for residents so that any changes in their health might be noted quickly and medical help sought if necessary. Whilst the* manager and staff know the residents very well, and talk to them all daily, there is no formal way in which residents and their families can give their views on how the home is run. Therefore, the manager has been asked to develop a formal quality assurance questionnaire so that the home can gather the opinions of the residents and any other interested parties. 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.V329402.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.V329402.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): 2, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All residents admitted for long-term care had a contract in place. Everyone had an assessment of their needs prior to admission and the home was able to demonstrate that it could meet the needs of its residents. EVIDENCE: All files examined showed that residents had been provided with contracts relating to their staying in the home. These contracts showed the amount of money which would be paid and the services which resident could expect in return. All but one service user who responded to our questionnaire said that they had been given a contract, and the other said it was being issued that week. Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 10 The manager meets with any prospective resident and family as part of the assessment process and collects various pieces of information regarding their needs. During the collection of this information, various forms were used, including some which used a scoring system. This proved to be confusing, as some scores were gathered and some were not. Those scores gathered showed no link to what the score actually meant and no action was planned as a result of any score. It is recommended that the manager should develop the initial assessment system to link to the headings which form part of the residents’ care plans. (See standard 7). All five residents who wrote to us said they had received enough information about the home so they could decide if it was the right place for them. One relative said; “My mother was in hospital when the placement at Bluebell Lodge was offered. The staff visited mother and me in hospital and then allowed me to visit and assess the facilities before making a decision. Excellent service”. There are no intermediate care beds in Bluebell Lodge. Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have most of their health, personal and social care needs set out in care plans, although these need to be reviewed on a regular basis. Their health needs are not fully met, as lack of assessment of equipment used to support them, failure to record fluid intake and failure to record moving and handling procedures, could mean that the residents were at risk. Residents are protected by the home’s medication policies and procedures. They feel they are treated with respect and their right to privacy is upheld. EVIDENCE: There has been a great improvement in the quality of information gathered in the care plans since the last inspection. Each resident now has a care plan which is drawn up with their input wherever possible. These plans include details of personal care needs, previous medical history, mobility and Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 12 communication skills. The care plans also highlight people’s likes and dislikes, and staff record residents’ general wellbeing on a daily basis. Although some residents in Bluebell Lodge have a degree of confusion, there was no separate mental health/cognition section. Similarly, although physical needs were identified in various places in the care plan, there was no separate physical health section. It is recommended that separate sections should be added so that people’s physical and mental health needs can be recorded. Risk assessments were in place for those residents who need them, and these included the risk of someone wandering off, the risk of falling, or the risk of choking. The action taken to minimise these risks was recorded. Once again the way that risk assessments were recorded varied, and they were stored in different places on each care plan. It is recommended that all staff use the same style of recording risk assessments, and that they should be clearly linked to the care plan. Of the five residents who wrote to us, four said thay always received the care and support they need, and one said “usually”. One family member said: “Bluebell Lodge is, in comparison, small. Therefore the staff give exceptional support to the residents”. As a result of the work undertaken in compiling a whole new set of paperwork, care plans and risk assessments had not had regular reviews. One person’s weight had been causing concern and a weekly weight chart had been introduced. This had not been completed for several weeks, and although staff were aware that there was now no cause for concern, there was nothing recorded to say that this was the case. The manager has been asked to ensure that all residents’ care plans are reviewed on a monthly basis. Risk assessments should also be reviewed at this time. All residents are registered with a General Practitioner (GP), and all other medical professionals are seen as and when required. This varies according to the needs of individuals. Both GPs who responded to our questionnaire said that the home “communicated clearly and worked in partnership” with them and that if any specialist advice was given, it was incorporated into the residents’ care plan. The home has good links with the local older people’s community team, and can call for support if any crisis periods arise. Care plans contained details of medical appointments made for residents, and one resident was waiting for an Occupational Therapy (OT) assessment regarding the type of walking frame she used. All five residents who wrote to us said they always received the medical support they need, and one relative said: “My mother has had a couple of falls, and the staff sought medical help then. On one occasion she had to go to hospital. She was accompanied by a member of staff”. Whilst visiting residents in their bedrooms, it was noted that some residents were using bedrails and grab rails beside the bed. Recent guidance has shown that there is a significant risk of residents trapped by these rails if they are not Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 13 the correct type for the bed. There was no documentary evidence to say that the use of this equipment had been professionally assessed, or that it had been agreed by the medical team and/or the families. There were also no risk assessments in place for the people using these pieces of equipment. The manager must ensure that reviews are sought regarding the use of bed rails for all those people to whom it applies, and ensure that risk assessments are in place regarding their use. Great care is taken to maintain healthy skin for those residents who may be immobile, and the local district nurse helps support staff in this. Two residents are currently being looked after in bed, and when talking to staff, it was clear that they were aware of these individual’s needs. Staff said that each of the two residents were turned in bed every two hours, and that this was recorded whenever it was done. Staff also said that they were monitoring the residents’ fluid intake, and offered a drink every time they passed the room. However, there were no recent records of these residents being turned and no records of fluids being offered. The manager has been asked to make sure that both of these things are recorded and monitored for residents so that any changes in their health might be noted quickly and medical help sought if necessary. Fluid charts should be totalled every 24 hours, so that a clear picture of how much each person is drinking is available. Significant improvements had been made since the last inspection in the recording of medication. One staff member has been designated to take responsibility for the home’s medication policies and procedures, and this has resulted in a much clearer system. Medication Administration Records (MAR) were completed although one or two signatures were missing. The manager and senior staff reported that these records are checked by them regularly, and staff who fail to sign are reprimanded and may be subject to disciplinary action. All medication received into the home was recorded, and a locked trolley is 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. Some medication is sent to the home weekly in dossette boxes, and others are sent monthly in boxes. Whilst examining the contents of the medication trolley it was noted that there were several boxes of medication belonging to a deceased resident. Although it is necessary for the home to retain this medication for a period of seven days, it is recommended that in cases like this the medication should be kept in the locked medication room instead of the trolley. This means that there is more Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 14 room in the trolley for current residents’ medication, and less chance of the wrong medication being given out. It was also noted that any tablets which had been refused or dropped had been placed in a large tub, which was then returned to the chemist at a later date. It was difficult to know what each tablet was, and therefore difficult to check back with the residents’ records. It is recommended that any dropped or refused tablet is separately identified, with the date, drug name, dose and resident’s name. This will make any stock check easier, and the tablets can still be returned to the chemist in the normal way. A recent pharmacy inspection by the local chemist was held and the home was told by them that their systems were very good. All residents spoken with confirmed satisfaction with staff members and expressed that his or her privacy and dignity were respected at all times. Staff were observed knocking on doors and residents were spoken to with their preferred form of address. Residents confirmed that all personal care was given appropriately and staff respected their wishes when they wanted to spend time in their room. 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. Both GPs who wrote to us said they always saw the residents in the privacy of their own room. Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities for residents within the home are limited, although this is likely to improve with the arrival 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. 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. One resident had a minister who visited when visiting the home and another attended church occasionally. Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 16 Some residents attend the local stroke club, usually twice every month. Of the five residents who wrote to us, two said there were “usually” activities and three said there were “sometimes” activities arranged for them to take part in. One relative commented that “The residents only get activities at Christmas and Easter etc. This would be my only criticism as I believe monthly or weekly activities would be stimulating”. Another said; “I feel that a little more activities would stop a lot of boredom within residents and help keep them active”. The home is planning to employ 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. 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 resident said she sometimes goes out for meals with her family and another drives a car, and is able to come and go as they please. All four relatives who replied to our questionnaire said that they could visit their relative in private and that they were consulted about their relative’s care if the individual concerned was not able to make decisions. One relative said; “My aunt is very content at Bluebell Lodge. The staff are very caring and I am quite happy with her situation. We often visit without prior warning and have found everything in good order”. 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. 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 home has a four week rolling menu, which will change according to winter or summer weather. The main meal of the day is usually at lunch time, and lunch on the day of the inspection was roast lamb with vegetables and roast potatoes, as well as a sweet. Although no alternative was recorded on the menu, staff reported that there is always something else available for those people who do not feel like eating the planned meal. Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 17 Any special dietary needs are recorded in the care plan, along with people’s likes and dislikes. Some people have to have a soft, mashed diet, and some have diabetic diets catered for. Most residents now eat in the dining room, which has comfortable seating and a view over the front of the house. One resident needed support with having food cut up because of a visual impairment and this was seen to be tactfully done. Four of the five residents who wrote to us said they “always” liked the meals and one said; “usually”. One relative said; “I have heard the residents commenting that the food is wonderful. I am often there when lunch is served and I see fresh vegetables and a choice of meats or vegetables”. Although a menu was available, there were no records kept of the food which residents actually ate. As nutrition is an important factor in the wellbeing of older people, the manager has been asked to make sure that this is done for each person. Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. 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, although no formal complaints have been made to the home. All five residents who responded to our questionnaire said they knew who to speak to if they were not happy and knew how to make a complaint. Three of the four relatives also knew about the complaints procedure. One said they did not, but added; “I have not enquired about a complaints procedure”. All relatives said they were satisfied with the overall care provided. One resident who wrote to us told us that they were concerned about clothes going missing from the laundry as they hadn’t been labelled. The manager was aware of this comment, and had dealt with the matter, although it had not been recorded. It is recommended that staff record even minor concerns or complaints. Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 19 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 also available. All staff have had training in Vulnerable Adults procedures, and have received certificates to evidence this. There has been one referral made to the vulnerable adults unit, and this was seen to have been dealt with appropriately by the manager. Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care which staff take to maintain the home means that residents live in a homely, comfortable, safe environment, which is clean and hygienic. EVIDENCE: Bluebell Lodge is a very comfortably furnished home with large airy rooms. Residents’ bedrooms were homely and each contained individual personal items. A great deal of work has been done by the provider in fitting radiator covers in the home, 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. The old fishpond has been drained and levelled off, and there are plans to install a patio area where residents can sit. The downstairs bathroom has been Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 21 refitted, and new flooring has been laid. The home has had a recent visit from the Environmental Health Officer (EHO) who carried out an inspection of the kitchen and ancillary areas. As a result of this, a new dishwasher has been ordered so that dishes might be washed at a temperature of 82 degrees or above. Five bedrooms have been re-decorated recently, as well as the corridor leading to the lift. There has been some subsidence in the building this year because of some tree roots from the garden. This has resulted in one of the home’s small lounges being taken out of use. The trees have now been removed and it is hoped that within a short time the lounge will be able to be re-decorated and used again. 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. All five residents who responded to our questionnaire said the house was always fresh and clean. . Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has the number and skill mix of staff to meet residents’ care needs, although the employment of a catering assistant would free up care staff to spend time with residents. A safe system for recruitment and selection of staff is in place. Residents are not supported by staff who have had all the training needed to support them. EVIDENCE: Bluebell Lodge continues to have three members of care staff on duty during the morning period, reducing to two for the afternoon and evening shift. There are currently two waking night staff, although it has been agreed with the Commission for Social Care Inspection (CSCI) that when the needs or numbers of the resident group dictate, one waking and one sleeping night staff member might be appropriate. There are two senior carers who take responsibility for more junior staff. The home also employs a cleaner and a gardener/handyman. Of the four relatives Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 23 who responded to our questionnaire, three said they felt there were enough staff on duty and one felt there was not. One relative said; “The staff/management are all very caring and look after my mother very well. I call to see her most days at varying times and I have no worries about her care, although more staff would help, especially at weekends”. Three residents replied that staff were “always” available when you need them, and two said “usually”. Previous inspection reports have noted that the home does not employ a catering assistant, and that care staff have to do all the menu planning, shopping and cooking. Shopping is now done over the internet, but this still means that one member of the care staff is taken away from their duties. In the mornings, when three staff should be available for caring for residents, one is always working in the kitchen. It is recommended that the providers should seriously consider employing someone who would specifically work in the kitchen preapring meals and snacks, so that the care staff might be able to spend more time with residents. Bluebell Lodge’s employment checks 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. Any staff who are subject to disciplinary measures have this clearly recorded in their file. Of the three staff files examined, none were seen to contain the medical information, and the manager has been asked to ensure that this is done in future. All new staff receive induction training around the homes policies and procedures and residents’ care plans. The manager is currently investigating a more structured training programme, and has contacted the Skills for Care training organisation. Six staff have completed NVQ Level 2 and two have done NVQ Level 3. One senior carer is studying for an NVQ Level 4 in Health and Social Care. Other training has included safe handling of medication, protection of vulnerable adults, basic first aid and fire safety. Dementia training has been booked for the future. Both General Practitioners (GPs) who wrote to us said that staff demonstrate a clear understanding of the care needs of residents. Training which still must be done,includes manual handling and infection control . The manager has been asked to ensure that staff have access to this training. Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a home which is run and managed by a person who is yet to be registered with the CSCI. The home is run in their best interests, although there is no formal way in which residents’ views are gathered. Residents’ financial interests are safeguarded, and the policies and procedures in the home try to ensure that their health, safety and welfare are promoted and protected. Staff are not appropriately supervised. EVIDENCE: Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 25 The(as yet) unregistered manager of the home, Mrs Christine Jenkins, has been in post since last summer. She is not yet registered with the Commission for Social Care Inspection (CSCI). She was previously a senior member of staff, has a good knowledge of working with older people and is well known by the current service users. She is supported by experienced senior staff, and will be seeking registration with the CSCI in due course, after all the necessary paperwork has been submitted to us. She is currently studying for her NVQ Level 4 in Management. The providers of the service, who are both experienced in the care of elderly people, own other homes throughout the country. The home is run in the residents’ best interests, although there is no formal way in which residents’ views are gathered.The manager visits all areas of the home and speaks to residents every day, which helps to foster good relationships. The views of residents are sought on a routine basis throughout the day. However, there has been no formal consultation with either residents or their families about what they like about Bluebell Lodge and what could be improved. The benefits of doing this were discussed with Mrs Jenkins, and she has been asked to ensure that a questionnaire is developed which will give people a chance to air their views. It would be good practice to ask staff and any visiting health and social care professionals for their opinions too. The response to the information collected should be sent to all the people who responded. Residents are encouraged to manage their own financial affairs with the assistance of their family members or representatives. The home does not undertake the role of appointee. Although no bank accounts are held for residents, the home manages the personal allowances for some of them. Clear records are kept of the small sums of money which are stored for residents. There were no records of staff supervision on file. Currently the manager supervises the two senior staff, but no formal supervision sessions for care staff have yet been started. The manager has been asked to ensure that formal, recorded supervision sessions take place at least six times a year. 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. Staff have training in basic food hygiene, and food temperatures are recorded on a regular basis. One staff member takes responsibility for fire safety procedures, and provides training for the rest of the staff. The portable electrical appliances were tested on 7th February 2007, and fire extinguishers and other equipment are serviced on a contractual basis. The home’s call bell system has been completely renewed, which means that staff now have to go to the room where the bell is operated in order to see who has called and what their needs are. Previously this was done from the central call panel, and if staff were Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 26 called away for any reason, meant that the call could go unanswered. Window restrictors have been fitted to windows where necessary, and risk assessments are in place for those which have not. It is recommended that the manager frequently reviews these risk assessments, as residents’ level of need change or new residents are admitted. Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 2 Standard OP7 OP8 Regulation 15 (2) (b) 13 (4) (b) Requirement Timescale for action 07/03/07 3 4 5 6 7 OP8 OP15 OP29 OP30 OP30 12 (1) (A) 17 Schedule 4, 13 19 Schedule 2 18 (1) (c) (i) 18 (1) (c) (i) 24 (1) (a) (b) All residents’ care plans and risk assessments must be reviewed on a monthly basis. Reviews must be held regarding 21/02/07 the use of bed rails for all those people to whom it applies, and risk assessments must be in place regarding their use. All residents who need fluid 08/02/07 intake monitoring and turning in bed must have this recorded. Records must be kept of the food 07/04/07 which residents eat. Each staff file must contain evidence of a satisfactory medical check. All staff must receive training in manual handling and infection control. All new staff must receive structured induction training in line with the Skills for Care specifications. A quality assurance questionnaire must be developed in order to seek the views of residents and other interested parties. DS0000040675.V329402.R01.S.doc 07/03/07 07/05/07 07/05/07 8 OP33 07/05/07 Bluebell Lodge Care Home Version 5.2 Page 29 9 OP36 18 (2) All staff must receive formal supervision at least six times a year. 07/04/07 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 4 5 6 7 8 Refer to Standard OP3 OP6 OP6 OP9 OP9 OP16 OP27 OP38 Good Practice Recommendations The manager should develop the initial assessment system to link to the headings which form the residents’ care plans. Residents’ care plans should have added sections relating to their physical and mental health needs. All residents’ risk assessments should be recorded in the same way, and they should be clearly linked to the care plan. Medication belonging to ex residents should be kept in the locked medication room instead of the trolley until it is returned to the chemist. Any dropped or refused tablet should be separately identified, with the date, drug name, dose and resident’s name. Staff should record even minor concerns or complaints. Consideration should be given to employing someone to solely do the cooking in order that care staff might spend more time with residents. The risk assessments relating to the lack of window restrictor should be reviewed frequently, as residents’ level of need change or new residents are admitted. Bluebell Lodge Care Home DS0000040675.V329402.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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.V329402.R01.S.doc Version 5.2 Page 31 - 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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