Inspection on 30/05/06 for Bluebell Nursing Home

This inspection was carried out on 30th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Nursing Home 25/02/09

Bluebell Nursing Home 06/08/08

Bluebell Nursing Home 26/02/08

Bluebell Nursing Home 10/07/07

Bluebell Nursing Home 03/10/05

Bluebell Nursing Home 06/04/05

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Winton House

Newbeech House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Bluebell Nursing Home 45 - 53 St Ronan`s Road Southsea Hampshire PO4 0PP Lead Inspector Ms Jan Everitt Unannounced Inspection 30th May 2006 08.30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 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.V289314.R01.S.doc Version 5.1 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 Techscheme Ltd t/a Bluebell Care Home Mrs Jacqueline Mary Hawes Care Home 51 Category(ies) of Dementia (15), Dementia - over 65 years of age registration, with number (15), Old age, not falling within any other of places category (51), Physical disability (51), Physical disability over 65 years of age (51), Terminally ill (51), Terminally ill over 65 years of age (51) Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Staffing levels apply Service users in the category of DE, OP & TI are only to be accommodated age 55 years and over. A total of 15 service users only in the categories DE and DE(E) may be accommodated in the home at any one time 3rd October 2005 Date of last inspection Brief Description of the Service: The Bluebell Nursing Home is registered to accommodate a total of 51 placements under seven different categories: older persons, terminally ill, terminally ill over 65 years of age, dementia, dementia over 65 years of age, physical disability, physical disability over 65 years of age. The home is situated along St Ronan’s Road, Southsea and is a short walk from Southsea pier, a predominant feature of the area, which is well serviced by local bus companies. The nursing home is comprised of five period town houses combined to create a single building, with three separate floors and two mezzanine floors, which could prove a little confusing when first arriving at the home. Local facilities are sparsely situated, although Southeas main shopping centre is only a 15-minute walk or 5 minute car journey from the home. Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit to The Bluebell Nursing Home which was unannounced, took place over a two day period on the 30th and 31st May 2006 and was attended by one inspector. A director of the company (referred to in the main body of the report as the proprietor) who owns the home assisted the inspector. The deputy manager, who has been acting in the clinical managers post also assisted and the newly appointed manager, who had commenced employment the day of the visit, observed the process. The visit to Bluebell Nursing Home formed part of the process of the inspection of the service to include all the key standards for the year 2006/7. The focus of this visit was to support the information gathered prior to the visit The judgements made in this report were made from information gathered prior to the visit, pre-inspection information submitted to the commission by the proprietor, information from previous reports, the service history and analysis of the accident/incident reports referred to as Regulation 37 reports, correspondence with the home and contact sheets that record all contacts that appertain to the service. Further evidence was gathered at the two-day site visit. The inspector toured the building and spoke with a number of the residents and a number of staff. Visitors were also spoken with to ask if they considered that their relative was being well cared for. Four relatives were spoken with over the phone and also a care manager who was visiting the home for a review of a service user. They all expressed positive comments about the home and the relatives were very happy with the care and commented that the home had improved tremendously over the past twelve months since the new owners took over. Two comment cards were received from the local GPs who serve the home both with positive feedback. One commented that the staff were ‘attentive to the service users and the patients were happy and well cared for’. The inspector viewed a sample of records, personnel files and spent time observing practices and speaking with residents. The atmosphere in the home was relaxed and unrushed and the staff were observed to work autonomously with clients whose activities of daily living routines they were familiar with giving them time to go at their own pace. What the service does well: Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 6 The company is continuing to invest in the upgrading and development of the service. The service users, staff and relatives are all aware and comment on the improving environment and how it has improved the quality of their lives. This was supported by a comment from a service user that has been in the home for many years and has observed the changes and reported that ‘things are so much better and you do not realise it until it happens’. The home has a review meeting yearly for every service user, family, key worker and the trained nurse, at which time they review all the care plans and discuss any issues and the appropriateness of the care plans or how they could improve the service delivered. The home was described by a number of relatives and a GP as welcoming and friendly and this has contributed to the reputation of this home improving with care managers happy to recommend and place their clients in this home. The home is clean and hygienic and bed linen and towels were reported to be changed daily. The staffing levels in the home are adequate and the proprietor is willing to increase staff numbers should the dependency of service users warrant this. The service users and families comments about the food and the variety of food offered were very positive and complimentary. The chefs produce wholesome meals and there are numerous choices from which the service users can choose should they not want the main menu. The chef goes to speak to all service users every day about their preferred choices for that day. The staff group appear to get on well together and the atmosphere in the home is that of a homely one with staff friendly and interacting well with service users. The service users appeared happy and well cared for. What has improved since the last inspection? What they could do better: Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 7 The pre-admission assessment tool could be expanded to include the psychological and emotional needs of the service users and identify more person centred needs. There is also a lack of social history documented that could be included in this assessment. The care plans need to be audited regularly to ensure they are reviewed at appropriate intervals and that they reflect the changing needs of the service user. Families/relatives should be invited to participate in the care planning process on behalf of the service user, if the service user is not able to participate or does not wish to be included. The activities coordinator needs more protected time from her care hours to plan and deliver the activities programme that should be designed around the service users capacities and their social histories. The home needs to review policies to ensure they are up to date and are based on the latest good practice guidance. Specific training needs should be identified and training provided. Training needs should be identified through the appraisal and supervision of staff that does not formally take place at the present time. The training officer should create a training matrix to easily identify all staff training needs and who has undertaken what training and when training is due to be updated. A quality assurance system must be put in place to enable the service to measure the success of meeting the aims and objectives of the home as stated in the Statement of Purpose. Housekeeping staff must pay more attention and adhere to the guidance on the handling and safe storage of hazardous substances whilst being left on cleaning trolleys unattended. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 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 Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Standard 6 is not applicable to this service. Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service and viewing documentation and speaking to service users and relatives. The pre-admission documentation is comprehensive in content, however, emotional and psychological and social assessments must be included as part of the assessment process. All service users have written statement of terms and conditions of residency in the home. EVIDENCE: The inspector viewed a contract of terms and conditions. It identified the room to be occupied and breakdown of fees between social and nursing needs and stated what was not included in the fees. Fees range from £486-668. The inspector viewed a letter sent to service user to inform them that there is a space available and states room number and fees. A sample of service user care plans was viewed. The pre-assessment document tool is comprehensive and covers all aspects of care. The assessment could identify more in-depth information about the emotional and psychological status of the potential service user and gain some social history Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 10 of the person. The home liaises with the care managers at the point of referral. The inspector spoke to a relative who confirmed that her mother was assessed by the home whilst she was in hospital prior to her being admitted to the home, and is very happy with the care she is receiving. Two of the sample of care plans viewed did not have a pre-admission assessment owing to the fact that the service users had been at the home for a considerable time and there was no evidence of a pre-admission assessment. Three of the four relatives spoken with reported that they had received information about the home and they had visited the home prior to their relative moving into the home. One person reported that he had visited about twelve homes in the area and this one was ‘far superior’ and that he and his wife had had an extensive tour of the premises. Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service, case tracking care plans, viewing records and seeking feedback from service users and relatives. Service users health, personal and social needs are met. The system for managing service users’ medication is robust and safe. Service users are treated with respect and dignity and their right to privacy is upheld. EVIDENCE: A sample of care plans was examined. All relevant information and that stated in Schedule 3 of the Care Home Regulations was recorded. The service users are assessed on admission to the home and risk assessments are undertaken and reviewed at intervals. A number of the risk assessments viewed by the inspector did not reflect the service user’s current status. One service user’s needs had completely changed and her condition had deteriorated considerably but the care plans continued to reflect how she was previously and her care was not being informed by documentation. Nutritional risk assessments did identify a score but the score did not correlate to a particular scale, and the service user had been assessed as at risk but had subsequently improved but Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 12 the care plan did not reflect this. The risk assessment for the use of bedrails states that service users are at risk and families request the use of bedrails. There is no evidence that this has been discussed with the service user in the first instance and if they are unable to consent for their use, neither their or their next of kin are consulted. There is no evidence that service users and families participate in the care planning process, however, a relative spoken to over the phone confirmed that she has seen the paperwork and is happy with the planned care. Another service user’s relative reported that she was very involved with her mother’s care. The home have a yearly review for all service users, one of which takes place weekly. The review includes the service user, key worker and relatives, at which time all care is reviewed and documented. It is at this point that relatives have the opportunity to discuss the resident’s care or any issues arising from it. The care plans do not record social histories or details of the emotional and psychological needs of service users, in particular those with dementia. In discussion with the new manager she reports that she will be reviewing the care planning system once she has settled into her post. The deputy manager acting as manager after the previous manager resigned, admits to not having had the time to audit the care plans to ensure they are current and updated, however, this must not detract from the observations of the inspector which was that the staff were familiar with the service users needs and their routines of the daily activities of living, and that there was a good rapport between staff and service users. Service users relatives spoken with could not praise the staff and care highly enough and reported they felt their relatives was ‘safe’ and ‘well cared for’ living at Bluebell. Each of the records inspected contained details of the service users’ general practitioner (GP), care manager and a document that recorded all contacts with any professionals allied to health. The home has thirteen different GP surgeries that attend the home. The manager says that this can be a logistical problem when ordering medication but that this has evolved over the years as service users choose to remain with the same GP if possible. Two comment survey cards were received by the commission from GPs and both commented that they had no concerns about their patients in the home. One GP commented that the home was very caring and attentive and that patients appear happy and well cared for. Community psychiatric nurses attend the home to review service users under their care. The deputy manager reported that the psychiatrist does visit the home to review service users if the home requests this. The podiatrist attends the home regularly and service users are not charged for this service. The inspector observed the morning medicine round with the deputy manager. The medicine trolley is taken from service user to service user who is observed taking their medication. The policies and procedures were recorded in the front part of the medicine chart folder. The MAR sheets were viewed and recorded appropriately. The deputy manager coordinates the ordering of Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 13 medicines. She reports that since the new system for administration of medicines has been introduced, she views the prescriptions before they are dispensed and as a consequence, overstocking and waste has decreased dramatically. There were no service users choosing to self-medicate at the time of the visit but the home has a policy should one choose to do so. The controlled drugs register was viewed. Night sedation is recorded in this and a check of the stock balance recorded correlated with the number of tablets in the pack. The controlled storage area is within a secure environment. The present proprietors have undertaken to create more single room accommodation and this affords privacy to the service users. Staff were observed to be treating service users with respect and knocking on their doors before entering. Relatives spoken with were very complimentary about the staff and how their relatives are treated in general. Service users were observed to look well dressed and those spoken with said they chose what they wear in the mornings. The inspector observed that one service user was choosing to wear shorts that day as the weather had improved considerably and his room becomes very warm. The inspector spoke to the training officer who reported that a wound representative was giving a training session in the home that afternoon and that one of the resident’s rooms was being used for this purpose. This was discussed with the proprietor as being totally inappropriate and invasive on service user’s private space and alternative training accommodation must be provided. Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service, case tracking care plans, viewing records and seeking feedback from staff, service users and relatives. The home does not provide a diverse enough programme of activities to meet the service users varying needs. Service users are supported and encouraged to maintain links with the community and their families. Service users are supported to make choices and control the activities of their daily lives. The home provides a well-balanced wholesome diet that is well presented in pleasant surroundings of their choice. EVIDENCE: The social activities programme for the home has improved since the last inspection. A carer has been designated to organise and document the activities programme for the home. The programme is displayed and includes Bingo, Vitalize, (exercises), Arts and crafts, films and reminiscence therapy. However, the activities’ carer has not undertaken any formal training for designing activities to suit those with failing mental capacity. The categories of service users living in the home is varied and therefore those with dementia mix for social activities and recreation with those who are physically frail. The inspector discussed with the carer and manager about the potentially wide range of social needs to be met and that the level of stimulation needed for a Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 15 person with dementia would be very different for a person who is only physically frail. The inspector suggested that the co-ordinator should undertake specific training and have more time devoted to this role. The carer/coordinator maintains a social record for each service user, which was suggested she created at the last inspection visit. The inspector viewed this. There are few social histories of the service users documented but the records show what activity the service user participated in for each day and to what extend they enjoyed that participation. She also records if they refuse and do not wish to take part. The coordinator has worked hard in her role to maintain and update these records. The home has written to families requesting social histories/recreational past times of their relatives. The inspector suggested that this information should be an integral part of the preadmission assessment process to ensure that all needs are identified and can be met by the home. A number of service users spoken with reported that they wished they could go out more. This was discussed with the proprietor who reported that a number of families do come to take their relatives out but the home does not have transport of its own to take outings. When possible service users are taken out in their wheelchairs but this is only possible if enough staff are on duty and weather permitting. The home holds a yearly barbeque to which relatives are invited and one relative spoken with reported that everyone has a good time. Another relative reported that the garden area had improved immensely and that now it was suitable to be used by service users in the finer weather if they wished to sit out. The care plans document religious preferences and also if the service user wished to practice their faith. The vicar does attend the home weekly and holds services and chats in the lounge. The visitor’s book documented regular visitors to the home daily. One relative spoken with reported that he visits the home daily to see his wife and the staff are always welcoming. He said he had been offered to take meals with his wife but has declined the offer. A number of visitors attend the home to undertake various activities such as arts and crafts. The hairdresser visits the home three times a fortnight and this is not charged to the service users. A resident confirmed this by telling the inspector that she gets her hair done free of charge. The manager reported that one of the service users pays for an agency carer twice a week to come and take him out into the community and for trips, this was confirmed when speaking with the service user, who had limited communication skills but was able to indicate that he was waiting for the carer to come that morning. The inspector observed that a good rapport existed between the service users and the staff. The proprietor is present in the home daily and the residents are Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 16 obviously familiar with seeing him around and were quite jolly when interacting with him. The inspector observed that staff were giving service users choices as to whether they wanted to get up and where they had their breakfast. One service user was asked if they wanted to get up and they told the inspector ‘I’m enjoying my lie in’. The inspector was informed by a member of staff that six residents are got up by night staff. This was discussed with the staff and they reported that these residents choose to get up early and are always the first up. One resident spoken to confirmed that he chose to get up early as he had always done. The inspector asked several service users if they were able to bring pieces of their own furniture to the home. They reported they had. One resident had chosen not to but the other one had been able to bring her favourite pieces and her room was very personalised. Most rooms had family photographs and pictures on walls and were individual to the occupier. It was observed to be more difficult in double rooms but there was evidence of personal belongings around. Several service users were asked about how they had chosen to come to live in the home. Some were unable to recall how they got to live in the home. Two other residents reported that their families had found the home for them and that they had trusted them to choose somewhere nice and that they had not been disappointed. The menus for the meals for the day were displayed in the lounge area. The menus offered a range of alternative meals if the main menu was not wanted. The chef goes around the home each day speaking to the service users and asking what they would like. The menu was varied and very well presented. The service users spoken with commented that the food was ‘very good’ and relatives spoken with confirmed this and reported that the variety and standard of food was ‘excellent’. Another relative told the inspector that his mother was on a special diet and that it was adhered to without any problems. The inspector observed a lunchtime meal being served. The food was of a good standard. The inspector observed that one service user requested different food and this was produced for her. Two residents requested wine with their meal and this was also provided. The atmosphere in the dining room, albeit small, was happy and communicative between service users. They reported they had enjoyed their lunch and the food was good. Most service users take breakfast in their own rooms and this is an unhurried routine when service users can go at their chosen pace. They have a choice of cooked or cereal. The first floor has a kitchenette and this is where the kitchen assistant makes the toast and beverages each day. The chef takes individual orders for cooked breakfast as they are phoned through to him. One service user was asked if she chose to have breakfast in her room, she told the inspector that she did, she was not an early bird and when she was ready she asked for her breakfast, which was the same every day, a bacon sandwich, which she ‘loved’. The chef was spoken with and he said he enjoyed cooking for the elderly as he had been used to a restaurant environment and that residents appeared to enjoy the variety of food he produced. However, he Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 17 identified that he and the second chef needed more specific training in special diets. The kitchen was toured and found to be clean and well organised. The Environmental Heath Officer has visited the home and has supplied the ‘Safe Food Better Business’ pack for the chef to use as an audit tool to ensure all the appropriate food and hygiene checks and systems meet the standards. All checks on temperatures are recorded. Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service, viewing records, discussion with the proprietor and staff and seeking feedback from service users and relatives. Service users are confident that their complaints will be listened to and taken seriously and acted upon. The home has an adult protection policy and procedure and staff are aware of the issues that surround adult protection and the procedures for reporting abuse. Training and awareness of adult protection is provided during the induction period. EVIDENCE: The home has a complaints procedure in place and forms part of the statement of purpose. The procedure is displayed in the front reception area. The home has a complaints logbook that the inspector viewed. One incident of missing money was recorded and this was dealt with under the adult protection procedure. The commission received a complaint from a relative in the later part of 2005. This was passed to the home for investigation under the services own complaints procedure and was subsequently resolved by them. Several service users were asked what they would do if the wanted to complain about anything, they told the inspector that they would speak to the staff or manager. Relatives spoken with were not completely aware of the complaints procedure but without hesitation said they would feel free to speak Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 19 to a member of staff or the manager should there be any issue to discuss. Staff spoken with understood about the complaints procedure. The home has the adult protection policy and procedure in place and staff are made aware of this procedure during the induction period. The proprietor followed the adult protection procedure following incident that took place in the home. The proprietor felt let down by social services and the procedure as he felt no one would take responsibility to bring the incident to resolution. Staff spoken to were aware of the adult protection procedure and in what circumstances they would report any incidents to the manager. Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service, touring the premises, speaking with staff, seeking feedback from service users and relatives and viewing the plans for the continual improvement of the building. Service users live in a pleasant environment that is in the process of being refurbished with a view to improving and increasing accessibility to all areas of the home and therefore the area is not free of risk at the present time. The environment is clean and hygienic and service users have the choice of having their personal possessions around them. EVIDENCE: A tour of the premises and comments from service users and relatives provided evidence that the home is well maintained and a good decorative standard is gradually being achieved with the ongoing refurbishment of the building. The building is quite extensive and spread out over five properties. The proprietor has made vast improvements in the layout and decoration of the home. Alterations to bathrooms and the creation of more single en-suite bathrooms continue to be undertaken in the home. At the time of the visit the Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 21 workman were putting in false ceilings and rewiring all the alarm systems and lighting systems. The inspector noted that the environment around the work area was quite hazardous and could present a risk to staff. A risk assessment must be ongoing for work around the home and prominent notices displayed identifying the risk. The proprietor informed the inspector, and showed her the plans of the continuing alterations and refurbishment programme, that this will be continuing for some time and there are plans to extend the building over the courtyard and move the kitchen to a more convenient location and create more single bedroom en-suite rooms and recreational space. The dining room is at present housed in a conservatory type extension and this could prove to be quite hot in the summer months. The plan is to move the dining area to the front of the house to an existing communal space. The inspector spoke to the maintenance man who is employed full-time at the home. He showed the maintenance request book for the day-to-day jobs. The inspector observed that a wheelchair was broken and being used, this was pointed out to the carer who immediately took the chair out of service and alerted the maintenance man that it was in need of repair. The overall appearance of the home is of a well maintained, pleasantly decorated home with a homely warm atmosphere. Relatives spoken with reported that they were very impressed with all the alterations and redecoration that has taken place. One daughter said of her mother’s room that is was so nice for her mother to be admitted into the home to a newly decorated room with an ensuite. Radiators are covered. A number of radiators have cage covers over them and the individual thermostats are unable to be accessed for adjusting the temperatures. This was discussed with the proprietor who reported that these are to be replaced gradually by the boxed in covers and that if service users needed the radiators adjusted they ask the maintenance man to do this. The tour of the premises demonstrated that the home is clean and tidy with no noticeable odours. Taking into consideration the amount of building works being undertaken at the time of this visit, the domestic staff were doing a good job keeping the area clean. The home employs a separate domestic staff, one of which is on duty every day of the week. The laundry area is housed in the basement and is a large area. All bedding is contracted out to a commercial laundry. Foul linen is put into alginate bags and washed before being sent to the laundry. Personal clothing was observed to be well laundered and neatly stored. Two relatives reported that they had had trouble with lost laundry but that this had improved and they ensure that nametags were in the service users clothes. The home has two sluice rooms; both are on the first floor. The builders are in the process of refurbishing one of these. The inspector viewed the infection control policy, which mainly states the policy for dealing with MRSA. This was discussed with the training officer who evidenced that a number of staff have Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 22 undertaken their infection control training. More recent information and guidance on best practice for infection control must be sought and policies and procedures built on this guidance and made available to the staff. The proprietor informed the inspector that all policies are under review and some are being updated. Gloves and aprons were observed as being worn by carers and hand washing facilities were prominent in all appropriate areas of the home. The inspector observed a cleaning trolley, which had toxic cleaning materials stored on it being left unattended in a corridor. This was discussed with the proprietor as to alternative storage for these substances. Staff spoken to later understood the COSSH guidance for the use and storage of substances hazardous to health and that they must not be left unattended. Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service, viewing recruitment files, staff rotas, discussion with the training officer and staff and seeking feedback from service users and relatives. The number and skill mix of staff on duty and stated on rotas should meet the service users needs. The home’s recruitment policy and procedures are thorough and robust. Staff undertake training to enable them to do their job, however, the training officer must create a structured training plan to identify renewal dates for training and also a way of identifying staff training needs appropriate to the client base they care for. EVIDENCE: The inspector viewed four week’s staff rotas. The staffing levels remain constant throughout the seven-day period but occasionally dip at weekends. This must be avoided. Agency staff are employed in the home if the permanent staff cannot undertake extra hours. The proprietor informed the inspector that he uses one agency, ensuring the same staff come to the home is possible. The dependency of the service users in the home is high. The staffing levels are 2 trained nurses in the morning with 8 carers, 2 trained in the p.m. shift with 6 carers and 2 trained and 3 carers for the night shift. The morning routines appeared well organised and staff were not rushing their Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 24 work, although the morning period was very busy. The home employs separate domestic staff, laundry staff and kitchen staff and there is a full-time administrator. From observations and conversations with the staff there appeared sufficient staff on duty to meet the needs of the service users in residence at the time of this visit. The training officer is included in the rotas and is supernumerary to the numbers on duty but reports that she works as part of the team if they are short staffed or busy. The staff-training officer was spoken with about the training plans for staff. She is qualified to NVQ level 3 and has worked at the home for a considerable number of years and professes that the home has vastly improved the training programme since the new owners have been in place. The training officer reported that 50 of staff have trained to NVQ level 2 and that a number of staff are undertaking their NVQ level 3. She reports that the two domestic staff are undertaking NVQ level 1 in support cleaning. The training officer showed the inspector the induction programme and reported that once a staff member has completed the induction they then shadow another carer for the following 2 months. All new staff undertake moving and handling and fire training before they can commence work. The training officer reported that before staff can undertake the NVQ 2 training they must undertake the Skills for Care Council foundation course and following this they will be tested to identify any weaknesses in their knowledge and then they are put forward for the NVQ. Level2. A sample of recruitment files was viewed. The recruitment process has been made more robust since the last inspection report stated that two staff had commenced employment without appropriate checks which had placed unreasonable risk to service users. The proprietor has grown from this experience and the recruitment process is thorough. One member of staff has POVA clearance but is still awaiting CRB clearance and is working under supervision. Staff spoken with described their recruitment process and most had seen the job advertised locally. A copy of the terms and conditions of employment and a job description were evidenced in the personnel files. The inspector discussed the staff training with the training officer and requested to look at the training plan/matrix. There is no training matrix to easily identify what staff training has been undertaken or being undertaken and what training has been identified as being needed. The training officer has created a board on the wall and all staff have a card and on this is the training they have achieved. She assured the inspector that she knows what training every member of staff has undertaken and what they are doing at the present time. This system, however, does not allow for the easy auditing of training completed nor does it readily lend itself to being tracked, which is important if renewal dates for qualifications are going to be kept up together and the new manager wishes to know the situation of the staff training. The inspector could not easily identify if all staff had undertaken their yearly health and safety mandatory training. The fire logbook identified all staff had Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 25 undertaken their fire training for the past year. The training officer reported that fire training is provided twice a year by an outside trainer. The training officer described many courses that are undertaken outside of the home and that she uses the Portsmouth City Council SCATS programme that is varied and the courses chosen appertain to their client base. How particular staff are identified as needing specific training, or if they volunteer to go on courses, is not clearly documented as supervision and appraisal of staff is not taking place at present. The proprietors pay for all training but not for the time for the training. The report of April 2005 identified that a new training room/office would be created. The report of October 2005 reports that the new training room office for the training officer had been created albeit small. The inspector visited this room at the time of this visit and it is located in the basement of the building and is extremely small and would not effectively accommodate a training environment. There was wound care training taking place in the home on the day of the site visit. This was being undertaken in a service user’s room. When the inspector spoke to the training officer about this being unacceptable she reported that the service user did not mind and that she did not use her room during the day. This was addressed with the proprietor as being totally inappropriate and he reported that this does not usually happen, the reason given that the inspector was using the treatment/training room as a base that day. In the forthcoming alterations and plans for the home, this room will be a bedroom so it is anticipated that once the final purchase of the next door house is completed, a room in this area will accommodate the training facility. The inspector suggested that for internal training to be effective a more suitable training area should be found. During this visit the inspector spoke to the chef who identified himself that he needed training in providing special diets and gain understanding into the reasons for service users needing them. The training officer must address this. Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 26 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service, viewing records, discussion with the proprietor and appropriate staff and seeking feedback from service users and relatives. The organisation has recruited a manager and is in the process of induction to the job and a training programme. The home does not have an effective quality assurance system in place to measure the success of meeting the aims and objectives of the home as stated in the Statement of Purpose. The financial system adopted by the home ensures that service users’ financial arrangements are safeguarded. Arrangements for staff supervision do not take place formally. As far as reasonably possible the home ensures that the health, safety and welfare of service users and staff are promoted, however, there are areas around risk assessment of the environment that need addressing and need to be ongoing through the environmental changes. Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 27 EVIDENCE: The commission had received a letter from the proprietor some weeks prior to the visit to inform them that the manager had left. This was discussed at the time and a timescale of no more than four months was given for the recruitment of a new manager. The home has now successfully recruited a new manager. On the first day of the visit the inspector met the new manager who had been appointed and had commenced her induction on the day of the visit. The proprietor has not yet informed the commission of this appointment and was advised to do so. This is the first management appointment for the new manager, she having been a deputy manager in another home. The new manager is a registered nurse and will apply for undertaking her Registered Managers Award once her induction period is over. She will also be applying to the CSCI to be registered as the manager. The proprietor is familiar with the process of undertaking this. The deputy manager had been managing the clinical day-to-day management of the home but the proprietor is in the home every day and hence the management arrangements have been split. The management of the home would appear open and inclusive and regular staff meetings are held, at which time issues and suggestions can be voiced. Records of these meetings are kept and displayed for those who could not attend. The staff report that the deputy manager and proprietor are approachable and they would go to them should they wish to discuss any issue/problem. The home could not demonstrate any documentation to evidence that quality assurance systems are in place. The previous report stated that the previous manager was going to undertake a service user satisfaction survey to be distributed in November 05. The proprietor reported at this visit that they have been returned but have not been analysed and used to influence future planning. However, a number of service users and relatives were spoken with and they displayed a high level of satisfaction with the care given and the general environment and services delivered in the home. Many commented that the quality of their life was better since the home had new ownership and this was echoed when speaking to relatives and staff. A social worker visited the home during this visit and she reported that she was quite happy to visit the home and undertake continuing care assessments and had no concerns with the home as to the care and environment. The deputy manager reported that internal auditing has not taken place but she has regularly audited the medication charts to ensure they are being completed correctly. The quality assurance of the home was discussed with the new manager and proprietor and it is anticipated that the manager will undertake quality audits of the systems in the home as stated in her job description, once she has settled in the job. To be inspected at the next visit. Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 28 The proprietor and administrator told the inspector that the home does not become involved with supporting service users with the management of their monies. The administrator reported that should service users wish to retain money within the home, lockable storage space is provided to keep it safe. Most of the service users choose to have family members’ support them with managing their monies. Some of the service users have professional services and independent advocates supporting them with financial management. The home does purchase items on behalf of service users and invoice them at the end of each month for the items brought. The home could not demonstrate that staff receive formal supervision six times a year. The new manager will undertake training in appraisal and supervision and it will be from that basis that regular appraisal and supervision for all staff takes place and is recorded, which in turn, will also identify training needs. Staff spoken with reported that they receive training and consider they are well supported in their roles. A risk assessment of the environment could not be evidenced. This was discussed with the proprietor as being necessary especially during the alterations to the home where risks are increased. A fire risk assessment has been recorded but is in need of updating and reviewing in light of all the alterations. Risk assessments for the home must be ongoing and reviewed regularly if any alterations to the environment are made. The fire logbook was viewed and the appropriate tests were undertaken at the specified intervals. The fire detectors are automatically checked every 15 minutes and if faulty an alert will appear on the fireboard. All taps have thermostatic controls fitted and the maintenance man randomly checks hot water temperatures regularly, which are recorded in a book. The inspector checked two taps randomly and both were within safe temperature parameters. Cleaning chemicals hazardous to health were found on a cleaning trolley unattended, this must be addressed and alternative accommodation found for the trolley when not attended by the domestic staff or the chemicals locked away during break periods. Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 29 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 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 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 30 Are there any outstanding requirements from the last inspection? NO Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 31 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 OP3 Regulation Reg. 14(1)(a) Requirement You must ensure that the preadmission assessment of the service user must include the service user’s psychological, emotional and mental health needs, when deciding if the home can meet their needs. Care plans must be reviewed monthly to reflect current status of service users and be updated with service user’s changing needs. Service users’ rooms must not be used for a training area. Service users must be consulted about and have their social interests and recreational preferences recorded, and provided for, having regards for the differing needs of the service user with mental frailty to that of the service users with physical disability. The chefs must undertake training in the provision of special therapeutic diets. The manager must support the training officer in the creating of a structured training matrix, that records training completed, staff training needs and renewal or update dates. Quality assurance systems must DS0000062757.V289314.R01.S.doc Timescale for action 31/07/06 2. OP7 Reg 15(2) 31/07/06 3. 4. OP10 OP12 Reg 12(4)(a) Reg. 16(2)(m)( n) 31/07/06 31/08/06 5. 6. OP15 OP30 Reg. 13(1)(b) Reg. 18(1)c(i) 30/09/06 30/09/06 7. OP33 Reg 30/09/06 Page 32 Bluebell Nursing Home Version 5.1 24(1)(3) 8. OP36 Reg 18(2) 9. OP38 Reg 13(4) be devised to enable the manager to monitor systems, based on the views of service users and to measure the success in meeting the aims and objectives and statement of purpose of the home. The manager must formulate a system for undertaking and recording staff supervision six times a year. The manager must ensure that all substances hazardous to health and used for cleaning purposes must be kept in a locked environment when not in use. The risk assessment for the home must be reviewed and up dated to reflect the current environmental changes to the home whilst refurbishment works are in progress. 30/09/06 31/07/06 Reg 13(4)c RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations It is strongly recommended that the activities coordinator be allocated more protected time for the organisation and delivery of the activities programme, to meet the varying needs of the service users. It is recommended that the manager contact the public health nurse in Portsmouth to obtain up to date good practice guidance for infection control. 2. OP26 Bluebell Nursing Home DS0000062757.V289314.R01.S.doc Version 5.1 Page 33 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 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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