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Inspection on 25/02/09 for Bluebell Nursing Home

Also see our care home review for Bluebell Nursing Home for more information

This inspection was carried out on 25th February 2009.

CSCI found this care home to be providing an Adequate service.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

CARE HOMES FOR OLDER PEOPLE Bluebell Nursing Home 45 - 53 St Ronan`s Road Southsea Hampshire PO4 0PP Lead Inspector Anita Tengnah/ Carole Payne Unannounced Inspection 25th February 2009 09:45 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 Nursing Home DS0000062757.V373940.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 Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bluebell Nursing Home Address 45 - 53 St Ronan`s Road Southsea Hampshire PO4 0PP 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) 023 9282 3104 023 9282 6109 suecollins@whnh.com Techscheme Ltd t/a Bluebell Care Home Manager post vacant Care Home 51 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0), Physical disability (0) of places Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Physical disability over 65 years of age (PD) 2. Dementia (DE) maximum number 15. The maximum number of service users to be accommodated is 51. Date of last inspection 6th August 2008 Brief Description of the Service: Bluebell Nursing Home is registered with the Commission for Social care Inspection (CSCI) to provide nursing and personal care to 51 people in the older person category. The home is situated in Southsea and is close to the pier and seafront, a predominant feature of the area, which is well serviced by local bus companies. The service is within access to local amenities of Southsea’s shops and the local hospitals. The nursing home is comprised of five period town houses combined to create a single building, with three separate floors and two mezzanine floors. The home has a small garden to the back with seating provided. Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience Adequate quality outcomes. An unannounced visit to the service was undertaken as part of the inspection on the 25th February 2009. The process included a tour of the service where a number of the bedrooms, communal areas and bathrooms were viewed. As part of case tracking staff and service users views were sought, care, staff and other records were looked at. We sent out our Annual Quality Assurance Assessment to the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. This is included in this report, as was information gathered by the Commission since the last inspection to contribute in assessing judgements in this report. We have sent out some surveys to the service and the comments received will be reflected in this report. What the service does well: What has improved since the last inspection? The development of a pre-admission process and documentation has been put in place. Records seen showed that the staff were using these. Care plans and risk assessments had been developed. An application for the manager to register with the Commission has been submitted. Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 6 What they could do better: 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 Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The pre admission process has been recently introduced and was satisfactory. There is no intermediate care provision at the service. EVIDENCE: The last inspection report required that an a pre-admission process is developed and put in place to demonstrate how the home will be assessing and ensuring that they are able to meet the needs of the service users prior to admission. We looked at two pre admission records for the recently admitted service users. This indicated that the home’s senior staff had assessed the service Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 9 users as part of the pre admission process. The assessments contained details of the people likes and dislikes, personal details, continence. Further development in the assessment to include where and how information had been received. Consideration of involvement of others including healthcare professionals was available in one of the assessments. One of the care plans indicated that the service user was uncooperative. This was unclear whether this was due to their mental frailty or due to their visual impairment. This was important in assessing if the service could meet people’s needs. The service has recently started admitting new service users to the home following the lifting of a voluntary agreement not to admit. There is a pre admission process in place. However this is not embedded and needs to be sustained in practice. We sent out our surveys and have received seven returned comment cards. The people told us that they had enough information and they have been supplied with a contract. One comment was ‘Everyone was very professional and yet welcoming.’ Another comment was ‘ When I visited, I was struck as how like a family home it was’. One of the service users said that their relatives was admitted into the service from hospital and commented that ‘Bluebell was the only one with a vacancy’ and that they had not received a contract. The manager confirmed that the home did not provide intermediate care. Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 10 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): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are care plans and assessments in place, however these are inadequate to inform care practices and ensure that all people’s needs are adequately met. The service users are supported to access healthcare. However referrals are not always followed up such as missed and refused medication, which could affect people not receiving their medication safely. Medication management does not always protect the service users. The staff treated the service users with respect when attending to them. EVIDENCE: Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 11 We looked at four care plans as part of this visit to assess systems and records that the home has put in place to demonstrate how the people’s needs would be met. We noted that a new assessment format and care plans had been introduced since our visit. We found that the care plans now contain moving and handling assessments and falls risk assessments. Information for the new service users was much clearer with risk assessments informing care planning. The assessments and care plans contained some information, however these did not accurately reflect all the current needs of the service users. There was some evidence that the care records had included skin integrity assessments such as Waterlow score. As part of the management and prevention of skin breakdown, the service users were provided with pressure relieving mattresses as their assessed needs indicated. We found that these mattresses were all set at different levels and there was no system in pace to demonstrate how these settings had been determined. The manager reported that the handyman’s advice was sought. The correct settings of pressure relieving mattresses are vital as these can be detrimental to the welfare of people as having no pressure- relieving mattress. Clear procedures and advice from the manufacturer was not available to ensure that these are managed safely at all times. The daily records of care were inadequate and did not show what care have been administered in order to inform practices and ensuring that all needs are met. One of the new service users care plan showed that detailed care records were available as this person was receiving a lot of input from the nurses. These showed how they have responded in order to meet the service user’s needs. However all the other care records seen contained little information except that they were washed and dressed. Another service user’s record contained detailed assessment of their needs on admission, however there were no care plans for their dietary needs or mobility to show how these needs would be met. This was brought to the attention of the nurse in charge at the time of the visit. This person had moved into the home a week previously and had specific needs which required care planning. There was a lack of assessments in relation to nutritional needs and incontinence at the time of the visit for people who had needs in terms of these areas of care and support. The nurse in charge reported that continence advisors from the community had completed continence assessments. We were unable to access these assessments record at the time of the visit. We were advised that these were kept in a separate folder and therefore not accessible to the staff providing care. Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 12 The care records contained some information about continence such as the type of pads in use. They lacked details about how the service users’ incontinence would be managed such as frequency of toileting, change of pads as appropriate in order to inform practice. The home has one member of staff responsible for monitoring pads and kept detailed records and charts to show the service users requirements. This good practice needs to be transferred in care planning to inform the staff practices. The risk assessment for dietary needs and request for swallowing assessment had been put in place for one of the new service users. One of the service users record showed that they were receiving thickened fluid and Fortisip drink. This was inaccurate as the nurse in charge reported that they were no longer taking any oral fluids and the record was changed at the time of the visit. We looked at the thickened fluids that a number of the service users were prescribed. The care records did not contain accurate information regarding the amount of thickening agents that need to be added. This can be to the detriment of the service users. As discussed this information should be available to the staff who are responsible for this procedure. We noted that in one of the rooms thickening agent had been added to fluid and left that could not be used as this had turned into a paste. One of the service users swallowing assessment was completed in 2008, and record showed that the service user’s needs had changed and no further assessment was available to ensure that care was provided as per their assessed needs. There was a lack of reviews in the care records that we looked at in relation to dietary assessments and Waterlow scores in order to accurately reflect the current needs of the service users. The nurse in charge reported that the service users are supported and receive care and support from the local Primary Care Trust. This included support with care planning and pressure ulcer management. We looked at the process that the home has introduced for the safe management of medication that the home undertook on behalf of the service users. We found that medication was stored securely and this included creams and ointments that have been prescribed. A random sample of the Medication Administration Record (MAR) was looked at as part of this visit. The responsible individual wrote to us recently to advise that they had changed pharmacist. The staff reported that the new system was working well. We observed that the new MAR sheets contained a photograph of Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 13 the service users and this was also noted on the prescribed dressing for one of the service users. Our surveys asked people if they received the care and support they needed. Five said ‘always’ one said ‘sometimes’ and another one said’ usually’. Some of the comments were: ‘Staff are responsive and attentive. I especially like the privacy of screening patients when moving them’. ‘My relative receives the care eventually, but there is usually considerable wait, Records of oral medication administered were recorded on the MAR sheets. However we noted that there continues to be gaps on the MAR records where the staff are failing to maintain accurate records of medication administered. One of the service users record showed that they had not received their medication at 22:00 hrs on the 20th of February 08. There was no record of why this was not administered, however the record was later changed when we checked again around lunchtime to state that this was missed. Records seen indicated that a number of medications were missed/ not recorded as given. One of the service users records showed that they had been refusing their medications on a number of occasions and there was no record to show what action the staff had taken such as advice/referral to their doctors. During the visit we observed that two white tablets were left on the table in a service user’s bedroom. This service user had been administered their medication and staff had signed for these. However the service users had not received this medication. This was brought to the attention of the manager who administered these tablets to the service user. The registered nurse who had signed for these tablets was not consulted as good practice indicates to ensure the service user was receiving the correct prescribed medication. An immediate requirement was made at the time of the visit for action to be taken to safeguard people using the service to ensure that they receive their medication safely. The home did not have a procedure in place for the administration of as required medication that can be to the detriment of the service users not receiving their medication as required. One service user was prescribed a medication to manage excessive salivation and there was no clear guidance when this would be administered and other medications included pain- killers and aperients. There were a lack of records in relation to creams and ointments that the staff were applying to the service users. This was brought to the attention of the Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 14 manager who asked whether this was necessary. Further guidance on the safe management of medication is available on the Commission’s website and the Royal Pharmaceutical guidelines. The staff were now recording food and fluids administered. Although there has been some improvement, there still remain periods of up to four hours when no fluid had been given/ recorded as offered. The staff spoken with confirmed that this service user is dependent on carers assisting with their drinks. We observed that staff were available in the lounge areas and supported the service users with their drinks and meals. Staff interacted in a friendly and caring manner with the service users. During the visit we found that one of the service users had been left in a wheelchair facing the cupboard and slipping out of her chair. The call bell was out of her reach. This was brought to the attention of the manager and action was taken. The manager said that the doctor had just seen the service user, however allocated staff should have ensured that the service user was comfortable and safe. We observed that during the visit the staff were generally attentive and interacted well with the service users. We observed that one of the service user’s belongings had been left in two black bags in their room. The manager said that these had arrived the previous day. In order to protect the dignity of people these should have been unpacked and stored when they arrived. Bluebell Nursing Home DS0000062757.V373940.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are some activities for the service users. However the records of activities and dedicated staff hours need to be further developed in order for this to be meaningful and meet the needs of all the service users. The service users are supported to maintain contact with their family and friends. The meals at the home were satisfactory, accurate records of food taken by the service users should be developed and put in place. EVIDENCE: The home has a planned activity programme for the service users that included external entertainers that came in on a regular basis. Some of the activities offered included arts and crafts, singer, films, cookery. The lady from ‘pat a dog ‘ was visiting the service at the time of the visit and reported that this was a fairly new activity and she was trying to get to know the service users. The home had employed an activity coordinator at the last inspection, however the responsible person stated that she had since left. Activity was undertaken Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 16 by the hairdresser and mainly happened in the afternoon. The records of activities for the service users were poor and this is particularly important as the service users accommodated have various degrees of dementia and would benefit from one to one time and others spent most of their time in bed due to their frailty. Comments we received were that there were some activities available such as Christmas party, summer barbecue and Wednesday live music and sing along. ‘The PAT dogs are always enjoyed’ ‘The hairdresser does a wonderful job.’ However for people who are bedridden there does not appear to have anything for them and the response was ‘never’ from two of those service users. Other comments were ‘bedridden’ ‘Being bedridden and needs a lot of complex care, his brain is active but his body no use to him’ ‘Mother is completely bedridden and does not move out of her room’ The development of meaningful activities for people with dementia would benefit the service users and for those confined to their beds. The records of activities that the service users had taken part in was poor. The responsible individual reported that more activities happen at the service and staff do not record. This is important in order to assess that social opportunities are monitored and individuals needs met. The home has an open visiting policy and there is no restriction on visiting. People can receive their family and friends in the Privacy of their rooms. There is also a newly refurbished area that was used as a library and quiet area for visitors. The home has in place a planned menu, which is changed regularly and the staff reported that residents’ likes and dislikes are taken into consideration. The process of offering choices involves the cook who goes round each day and tells them what the menu for the day is and if this is not to their liking then an alternative choices are available. We observed that the lunchtime and teatime meals records were maintained. However the meals offered at breakfast were not recorded and the menu cards seen were not dated and did not accurately reflect what the service users had eaten. From our observation it was apparent that a number of the service users were served breakfasts in their rooms, accurate records of meals served/ eaten should be available in order that people do not get missed. This was brought to the attention of the responsible individual and action plan will be in place to ensure that records of all meals are available at the service. Staff were observed to be available to offer support to the service users with their meals in a sensitive manner. Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 17 Bluebell Nursing Home DS0000062757.V373940.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): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaint process is satisfactory. There are inadequate records in place relating to safeguarding referrals and any action taken. EVIDENCE: The home has a complaint procedure and a record of complaints received was maintained. The record seen showed that the service had received four complaints that had been investigated and details including action taken were recorded. A complaint log should be developed to ensure that records as required for inspection is easily accessible and current. We have information that there have been three safeguarding referrals made about the service since the last visit. There were no records at the home about these referrals, investigations and action plan. This was brought to the attention of the responsible individual and the manager who had been party to the outcome of these investigations. Clear procedures must be developed and put in place in relation to the home’s responsibility following safeguarding outcome and action plan to demonstrate Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 19 how the home has dealt with them. Records of the referrals and any outcome must be clearly recorded as required. The records seen indicated that the staff had completed training in the safeguarding adults. The home must ensure that the updated safeguarding procedures is accessed and put in place and staff are updated with its contents as this was not available at the time of this visit. We noted that two staff members had been given written warnings following an incident where they used inappropriate moving and handling practice that was to the detriment of the service user. This incident was not reported to us as per Regulation and the responsible individual must ensure that the Commission is kept informed as required. Comments from six service users indicated that there are able to raise their concerns. One comment was ‘ mother suffers from dementia, and also quite deaf in her left ear, still waiting to hear about a hearing aid.’ Bluebell Nursing Home DS0000062757.V373940.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): 19,26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is warm and homely and meet with the satisfaction of the service users. There is a satisfactory process in place in relation to infection control practices. EVIDENCE: We walked around the service as part of the visit and looked at some of the service users’ bedrooms, kitchen, communal lounges, dining rooms and bathrooms. We looked at twelve of the service users’ bedrooms and found that they were personalised with personal belongings that they had brought in on admission. Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 21 It was evident that there is a programme of refurbishment. The service has adapted one of the bedrooms into a quiet lounge/ library. This area was comfortably furnished and provided extra communal space for people to meet in private. The responsible individual also discussed that they were in the process of changing one of the shared room to a single room with a separate sitting area. The home has a laundry where all the service users personal laundry is undertaken. We did not look at the laundry during this visit. We noted that staff were using gloves and aprons, and discussion with staff showed that they were aware of infection control procedures. All the areas of the home that we looked at were in good decorative order and clean. There was no malodour at the time of the visit. All the comments we have received were positive in relation to the cleanliness at the service. Bluebell Nursing Home DS0000062757.V373940.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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing numbers do not fully protect people using the service, such as night duty hours. There is an ongoing training programme in place to support the staff in their roles. Recruitment procedures were inadequate such as criminal record bureau checks and did not promote safe recruitment practice, to ensure that people are fit to work with the vulnerable people living in the service. EVIDENCE: We looked at the duty roster to assess the staffing arrangement that the home had in place to meet the needs of the service users. The records showed that there were eight carers and two trained nurses on the early shift. There were two trained and five carers in the afternoon. Night duty had one awake trained staff and sleeping staff and three carers according to the duty roster and the responsible person confirmed this. The duty roster did not clearly indicate the hours that the staff were working in particularly on night duty. The responsible person said that the sleeping staff worked until 23:00 hrs, however this was not reflected on the roster. Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 23 Some of the comments we have received were complimentary about the service , however three were also negative about the staffing attitude and numbers. Comments included: ‘Any small request are immediately acted on.’ ‘He is afraid to complain or say anything to the nursing staff, he is very vulnerable.’ ‘The matron is wonderful and the nursing staff adequate.’ ‘I can talk to any member of staff and management.’ ‘The carers could be much better, there being quite a turnover of staff and never enough it seems’. The two staff comments we received indicated that the induction was good and covered policies and procedures. Comments from the two staff were: ‘The service maintains meetings for all the staff to place their views, new ideas across.’ ‘Though conversation with the resident in the evening is very hard as only certain amount staff on’. ‘Night staff does try to the best of their ability.’ ‘Night time would be better if more one to one was given to residents when needed or asked.’ ‘Could have more staff on duty to spend one to one with service users.’ We observed that staff attended to the service users in a respectful manner at the time of our visit. The registered person must ensure that there are adequate staff and in sufficient numbers to meet the needs of the service users at all times. This should include night duty. We looked at two recently recruited staff as part of this visit. Records showed that they had completed an application form. The provider also sought Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 24 references as part of the checks. We found that for one of them this was appropriate, however for the other carer this did not contain reference from a care setting as required. The records lacked clear audit trail for employment history. Checks such as Criminal Record Bureau (CRB) and POVA first were requested. However both of these staff were working at the service prior to full disclosure for CRB had been completed. The record that we looked did not reflect how supervision was recorded. There were two people on duty at the time of the visit without a CRB clearance and were included in the number of staff working. They were seen working independently. According to the home’s diary these carers are allocated to work in pair. Other area that records of agency staff that the home was using. There were inadequate records to demonstrate that the staff had the required skills to deliver the care. The full name and hours worked by any agency staff and in what capacity maws not clearly recorded. The provider must ensure that all necessary checks are completed prior to employment in order to safeguard the welfare of people living at the home. There were no records of additional supervision that must be in place as part of employing staff prior to their full clearance had been received. We looked at a sample of the training records that the service has in place. The home has employed a trainer for 18 hours per week and a training matrix was available. Recent training included induction, health and safety and the responsible person said that mandatory training is completed as part of the home’s induction. The new staff have the short in house induction that they complete and then moved on to the common induction standards. We found that two staff were undertaking an updated appointed first aid training next week. The responsible person confirmed that there was inadequate appointed first aid staff to cover all the shifts as required. Two other staff were booked to undertake this training. Following a recent safeguarding investigation there was an issue regarding training in syringe driver for the staff in order to them to deliver care safely. The nurse in charge reported that training had not been completed. They have been in contact with the trust nurses and had been told that this would be provided when needed. There is an ongoing National Vocational training Programme in place and a number of the staff were undertaking this training at the time of the visit. The registered nurses had also completed training courses with the PCT to enable them to meet the nursing needs of people living at the home. Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 25 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): 31,33,35,37,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has recruited a manager who is completing the fit person process in order to register with the Commission. The home has been without a registered manager for twenty months who is skilled and fit to manage the service. There has been recent introduction of internal audit, however this is not currently sufficiently detailed to ensure that people’s views are being fully reflected in outcomes for people living in the home. Risk assessments, medication management, recruitment processes are not fully implemented to ensure that care is provided safely. Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 26 EVIDENCE: The home has recently appointed a manager for the service. The manager has started the process of processing her Criminal Record Bureau (CRB) check and submitted an application to register with the Commission. Information we have received indicated that the responsible individual has said that the commission had accepted him as the temporary manager; this is inaccurate. The registered person was required to establish and maintain an effective quality assurance and monitoring systems, which seeks the views of the people who use the service. According to the record, the home had received 7 comments cards that were positive. Three of these were negative and related to the staff’s attitude and number of staff that the home must address. The responsible individual was required to undertake monthly- unannounced visits to the service to monitor how the home is meeting its commitments as stated in the statement of purpose. Record seen indicated that this had commenced and records of these visits were kept at the home. The responsible person has confirmed that the home did not manage any of the service users personal allowance. The service users/ relatives were invoiced for items such as chiropody and hairdressing as required. Detailed records of transactions were maintained at the service. We noted that an incident that two staff involved in inappropriately lifting a service user was not reported to us as per Regulation. This had the potential of putting the service user at risk of harm. The responsible individual must ensure that the Commission is kept informed as required. The responsible person stated that the home had an ongoing service contract in place for the upkeep/servicing of the home’s equipment. Details of checks for hoists and the bath hoists were available. The gas central heating was reported as serviced in September 08. The responsible person must ensure that details of service for all equipments are maintained and available at inspection as required. As stated in previous section of the report, the medication management and staff practices observed did not fully protect people using the service. Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 27 Care plans and assessments including dietary needs were not adequate to protect people living at the home. Care hours and recruitment processes were inadequate at the time to protect people using the service. Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 28 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 2 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 2 Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 13(4) 15 (1) Requirement The registered person must ensure that following assessments detailed care plans are put in place to demonstrate how the service users’ assessed care needs would be met. Including appropriate management of pressure ulcers, continence management and its prevention. Timescale for action 15/04/09 2. OP8 14(1) (a) Schedule 3 (o) The registered person must 15/04/09 ensure that the service users health and personal care needs are fully met at all times through detailed dietary assessments and action plan to meet those needs. The registered person must ensure that arrangements are in place for the safe administration, recording of medication received into the care home. This must include prescribed wound dressings. Immediate requirement made at the time of this visit. The registered person must DS0000062757.V373940.R01.S.doc 3 OP9 13(2) 15/04/09 4 OP18 12(1) 15/04/09 Version 5.2 Page 30 Bluebell Nursing Home 17(1) (a) Schedule 3 5 OP27 18(1) (a) 6 OP28 18(1) (b) 7. OP29 19 (1) ensure that records of all safeguarding incidences/ reports and all action taken following investigations are maintained at the service. The registered person must ensure that there are adequately trained staff and in sufficient numbers to meet the assessed needs of the service users at all times. The registered person must ensure that the staff have the skills to deliver care safely and nominated first aid training. The registered person must ensure that all necessary checks are in place prior to employment including full CRB. The registered person must ensure that reports as required by Regulations are sent to the commission as required. 15/04/09 15/04/09 15/04/09 8 OP37 17(2) 15/04/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bluebell Nursing Home DS0000062757.V373940.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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