CARE HOMES FOR OLDER PEOPLE
Bluebell Nursing Home 45 - 53 St Ronans Road Southsea Hampshire PO4 0PP
Lead Inspector Mark Sims Unannounced 6th April 2005 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 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 Version 1.10 Page 3 SERVICE INFORMATION
Name of service Bluebell Nursing Home Address 45 - 53 St Ronans Road, Southsea, Hampshire, PO4 0PP Telephone number Fax number Email 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 Hawes Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (OP), Terminally ill over 65 years of age (TI(E)), of places Physical disability over 65 years of age (PD(E)), Terminally ill (TI), Physical disability (PD), Dementia - over 65 years of age (DE(E)) (15), Dementia (DE) (15) Bluebell Nursing Home Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Staffing levels apply, service users in the category of DE are only to be accommodated age 55 years and above, a total of 15 service users only in the categories DE and DE(E) may be accommodated in the home at any one time Date of last inspection NA Brief Description of the Service: The Bluebell Nursing Home is registered to accommodate a total of 51 places under seven different categories: OP, TI, TI(E), DE, DE(E), PD & PD(E). The home is situated along St Ronans 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 a 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 Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The current owners purchased the care home on 1st November 2005 and since that time a sustained period of redevelopment, redecoration and corporate branding has ensued. Staff have also benefited from the change in owners with levels of support and training far exceeding that provided by the previous proprietors. The creation of specific positions within the home, such as the training organiser and activities organiser, provide staff with additional senior levels of guidance. Generally the patients were happy and pleased with the service they received at the home. Staff were described as helpful, friendly and respectful, although a propensity towards not knocking on doors before entering rooms was noted. People were also quick to point out the environmental changes that had occurred since the change of owner, with the addition of the new dining room mentioned on several occasions. What the service does well: What has improved since the last inspection?
From time spent touring the premises and based on the comments of patients, relatives, a company director, home’s manager and staff the biggest change or changes affecting the home revolve around the building, which is being redecorated, refurbished and generally redeveloped from top to bottom. Bluebell Nursing Home Version 1.10 Page 6 As previously identified one of the biggest gains for the home since being taken over is the dining room, which service users really appreciate. A new nurse call bell system also appears a popular addition, with one patient pointing out that now when you press your bell you know someone is coming to see you, before the home operated an intercom system, which was less personal from a caring prospective. The increase in staffing numbers, especially at night, has dramatically improved the service for people, as will the creation of posts like training officer and activities co-ordinator. Problems encountered with the medication system have been addressed making the process of delivering and administering medicines safer and quicker. In conversation with qualified members of the staff team and the management it was apparent that the changes already implemented are just the beginning with a new Monitored Dosage System (MDS) being introduced later in the month. What they could do better:
A number of issues where the home could improve its practice came to light during the inspection: Since taking over the business, moving and handling has been a key focus within the home, staff receiving updated training and new equipment supplied to ensure sufficient aids are available to support patients. However, during the visit a number of issues were noted which indicate that the training provided to staff many not be sufficient to address ingrained practices such as wheelchairs being tipped backwards whilst being used with patients and footplates not routinely used when transporting patients around the home, both practices endangering patient safety. Social stimulation was found to be limited for patients who throughout the twoday inspection relied heavily on television and self-directed activities for entertainment. Whilst it is acknowledged that external entertainments are planned and that during conversations several service users discussed their preferences of external entertainments, the programme devised by the home lacks substance with only nine days in April scheduled to incorporate extra activities. The creation of the new activities co-ordinator’s role should over time help address this imbalance provided time is allowed for the development of suitable activities schedules. A concerning trend within the staff team is their propensity towards entering people’s bedrooms without knocking first, which raises questions around the promotion of dignity and respect. Whilst many bedroom doors within the home are open, precluding the need to knock before entering, some service users prefer to keep their doors closed and made comment of the fact that staff even if they do knock do not always wait for a reply before entering the Bluebell Nursing Home Version 1.10 Page 7 room, despite a notice being placed on doors stating ‘please knock and wait’ before entering. At present the supervision programme for staff is informal, with no clear agendas established for discussion with staff. This issue, given the fact that the home has only recently been taken over by the new proprietary company, is perhaps not surprising. However, given some of the problems identified during the inspection i.e. moving and handling, promotion of respect and dignity, training needs for staff, etc. supervision is perhaps a worthwhile management tool that should be introduced. On the face of it Health and Safety seems to be an issue that the management generally takes seriously, with risk assessments in place for aspects of a patient’s care where injuries might be caused, health and safety statements available for staff and notices associated to health and safety issues distributed throughout the home. However, practices such as tipping wheelchairs and transporting people in wheelchairs without footplates undermines much of the management’s good work and places patients and staff at risk of injury. In addition some of the equipment used, i.e. hoist slings, etc. need regular maintenance and those that are not fit for purpose disposing off. It is also imperative to ensure that environmental risks are not only identified but actions taken to limit the possibility of accidents, as with a slope on the second floor, where a slight ridge is encountered prior to climbing the slope. Cleanliness was generally good around the home, especially when considering the amount of redevelopment, redecoration and refurbishment ongoing. However, whilst touring the premises it was noticeable that dust is collecting on most high surfaces, which when raised with the management appeared to be associated with domestic staff’s concerns about working at levels above shoulder height. It is suggested that if suitable risk assessments are undertaken and appropriate equipment supplied that this issue should cease to be a concern for staff. The home’s hoists and wheelchairs were also noted to require cleaning, which could be undertaken by care staff, as most appeared to be heavily dustcovered, posing a source for bacterial growth and a potential source for infection. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bluebell Nursing Home Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Bluebell Nursing Home Version 1.10 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 standard(s) 3 The home’s pre-admission assessment is a comprehensive document designed to collect information specifically related to the needs and wishes of patients being admitted to the home. This documented evidence is used in the generation of the service user plan, which is created prior to the person arriving at the home and is then subjected to regular review and update. EVIDENCE: Only one pre-admission assessment document was seen during the inspection visit, due largely to the current proprietors only having been in charge of the business since November. The document seen was a comprehensive record that comprised sufficient information for the home to generate a service user plan prior to the patient arriving at the home, providing staff with key information about the patient ahead of their admission. Bluebell Nursing Home Version 1.10 Page 10 In conversations with several people residing at Bluebell Nursing Home it became apparent that they were aware of the documentation the home held about them, including assessment records and most noticeably care plan briefing sheets for staff, which are located within the patients’ bedrooms. The new company maintains copies of its own pre-admission assessment documentation along with the new care planning system it has introduced. Anyone residing at the home prior to the new owners taking over the running of the home has been supplied with a new care plan and care planning briefing sheet, although no pre-admission assessments are available, as old records have been archived. Staff observed during the two-day inspection process would appear to be coming to grips with the newly introduced documentation and happily chatted to the inspector whilst completing daily reports. It was also apparent that sufficient time is being allocated to staff for updating these records and that on a day-to-day basis staff are deployed to work within set zones caring for specific patients residing within those areas. Bluebell Nursing Home Version 1.10 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 standard(s) 7, 8, 9 Seven care plans were reviewed in total across the two days of the inspection. These were largely found to be informative records, which contained information in sufficient detail to enable staff to care for the individual needs of the patients. Each record inspected contained details of the patient’s general practitioner, care manager, etc. and a specific document for recording all contacts with health and social care professionals visiting the home. Systems for managing patients’ medication were tested directly with staff and found generally to be robust and organised, ensuring within reason that patient safety and wellbeing is promoted. EVIDENCE: Case tracking took place with five service user plans with a further two care plans reviewed on day two of the inspection process by the second inspector. The information contained within these documents is largely reflective of the needs of the patient, based on observational evidence and the guidance provided to staff in the form of the brief care plan resume retained in the patient’s bedroom.
Bluebell Nursing Home Version 1.10 Page 12 On day two of the visit the inspector(s) focussed more on people who chose to remain within their bedrooms, where it was clear that they knew these briefing sheets existed and that the information contained within the document related to their specific care needs. Across the two days of the inspection the service users were very clear that the staff cared for them extremely well, describing them as courteous and approachable. Relatives of patients also stated how much they appreciated the high levels of care and support provided to their next of kin(s), whilst residing at Bluebell and adding that this friendly and supportive approach extended beyond care of patients to include support and friendship of visitors and relatives. Staff spoken with during the visit felt that improvements to the home’s staffing levels and skill mix had eased issues around the administration of medications to service users, with two qualified nurses on each shift. At no point during the visit or the ensuing tour of the premises was any medication noted being left with patients, staff preferring to remain with people to ensure their prescribed medications were being taken appropriately. Bluebell Nursing Home Version 1.10 Page 13 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 standard(s) 12, 15 Social activities are limited, although the recent appointment of an activities co-ordinator should given time address and improve this situation. Meals and menus appeared to be well balanced, nutritious and afford patients choice and variety. EVIDENCE: In conversation with the activities co-ordinator it was clear that whilst she is new to the home, having commenced employment in January, that she has skills relevant to her new role and that given time (both experiential and developmental) should be in a position to develop a healthy activities schedule incorporating both internal activities and external entertainments. A limited activities programme is presently available to the patients; copies of forthcoming events are normally advertised around the home, although at this visit these were not seen until asked for by the inspectors. In conversation with patients across the two days quite different pictures of people’s social experiences were brought to light, with those people who congregate in the communal areas able to discuss/describe the external activities providers who visit the home and the relative merits of their visits based on preferences, whilst those who opt to spend time in their bedrooms
Bluebell Nursing Home Version 1.10 Page 14 have little access to social stimulation beyond that offered by staff and relative visits or audio/visual aids, radios and televisions, etc. It was also apparent from talking to those people assembled within the communal areas that beyond the external activities already discussed there was little in the way of meaningful social stimulation or entertainment, unless you were able occupy your own time, as in the case of one patient who had taken on the role of stitching labels into people’s clothes for them, an activity she found fulfilling and therapeutic. The home’s approach to meals and mealtimes was praised continually throughout the two-day inspection programme, with the new proprietors’ menus preferred to those produced by the previous owners, the standards of the cooking complimented and the addition of the new dining room commended During conversations with patients it was identified that the cook sees everyone daily to discuss menu preferences/options, etc., a fact confirmed by the cook, and that alternatives to the main dish are always available if required. The catering records indicate that the home operates a four weekly rotational menu, with individual records maintained of the meals selected by patients. Some positive changes have been made to how mealtimes are managed since the new owners took charge, which include, as mentioned, the creation of a service user dining room, the introduction of heated trolleys to ensure meals served to people within their bedrooms remains hot when delivered and a new cooker and shelving units. One area of slight concern brought to the attention of the inspector(s) revolves around evening or suppertime snacks, several patients commenting on how they have nothing to eat from 17.00hrs to 08.00hrs the next day. When raised with the cook she seemed a little surprised given she leaves a plate of sandwiches for suppertime and the home has a variety of biscuits, etc., which should be offered with the evening drinks. This issue was also discussed with the management who were equally as surprised and responded to the concern raised in the same manor as the cook; the issue is to be addressed. Perhaps one of the most pleasing aspects of the visit to Bluebell was associated to mealtimes, specifically on this occasion lunchtime, when dinners served to several of the patients were noted to be accompanied by an alcoholic beverage, which according to patients spoken to was a regular occurrence. Bluebell Nursing Home Version 1.10 Page 15 The cook confirmed that drinks were served with meals on average twice a week, although some people obviously had a tipple more often and some less often depending on preferences and medical guidance. Bluebell Nursing Home Version 1.10 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 The home’s complaints procedure whilst clearly defined within the statement of purpose, service users’ guide and displayed within the home, could be brought to people’s attention more directly, as history suggests that people prefer to bypass the home’s policy in preference for direct contact with Social Services. Copies of the Local Authority adult protection procedure are available to staff within the home and discussions were held with the training officer re introducing an adult protection training programme for staff, as the current system lacks any structure. EVIDENCE: Several patients were asked about how they raised concerns or made complaints if they were unhappy with the service being provided within the home. Generally people indicated that they spoke to staff if they were unhappy or concerned with any aspects of their care and that this usually was sufficient in addressing the problem. A specific occurrence relayed to the inspector(s) involved a patient’s drink, which on two occasions was found to be too sweet. It was understood that this was brought to the attention of the cook directly, although an outcome or resolution to the concern was unknown at the time, as the patient had not had a drink since speaking to her (no drinks round). On speaking to the cook she was able to explain that she had spoken with the kitchen/ancillary assistant responsible for taking drinks round to patients and
Bluebell Nursing Home Version 1.10 Page 17 had asked her to use less sweetener in the person’s drink, which she hoped would resolve the problem. People generally, when asked, stated that they found the new management team to be approachable and willing to listen, a fact emphasised by a visitor to the home who praised the care her recently departed husband had received in the home since it was taken over, describing the management as supportive and caring people who were willing to make time to listen and help with any problem/issue. Adult protection training was discussed with key members of the staff team and found to be an area of the home’s training programme that required attention, as whilst the home has information in the form of Local Authority guidance leaflets and an in-house policy, it has no specific educational or instructional training tool. Adult protection awareness is an important part of any staff training and development package, as a lack of knowledge around protection issues can directly impact on service users, who are considered a vulnerable and at-risk client group. The protection of vulnerable people however extends beyond just training and development strategies, embracing culturally important issues such as openness, trustworthiness and clear pathways of communication and leadership. Through discussions with patients, relatives and staff and using observational skills whilst touring the premises and meeting with people the inspector(s) were able to form an impression of a home where generally staff are perceived as friendly, supportive and caring and have developed good relationships with many of the patients and their visitors. However, from a team perspective some issues were identified which if left unaddressed could lead to problems in the future, issues such as the perceived existence of non-challengeable hierarchy within the qualified staff team or the propensity for some staff to dismiss people’s right to dignity and respect, as demonstrated by not knocking doors before entering. Hopefully the encounters inspector(s) had with such practice/issues were isolated and problems which the new owners will address successfully through training, education and support. Bluebell Nursing Home Version 1.10 Page 18 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 standard(s) 19, 21, 22, 26 The new proprietary company and management team are taking steps to increase the provision of equipment and aids for the support of service users. Adaptations are also being made to the premises with the specific purpose of improving the environment and increase accessibility to all parts of the home used by patients. Several new walk-in showers have been created and a number of en-suite facilities installed in service users’ rooms, which is improving the environment. Cleanliness levels were reasonable, despite the reluctance of domestic staff to address issues of high dusting, which clearly had not been tackled for a while, given the layers of dust and cobwebs visible. EVIDENCE:
Bluebell Nursing Home Version 1.10 Page 19 The tour of the premises enabled the manager and one of the company directors to highlight for the inspector(s) the improvements they have made to the home since purchasing it in November 2004, these included: • • • • • • • • • • The addition of two walk-in showers The recovering of a ramp with a non-slip surface. Redecoration and re-carpeting of several areas of the home. The redecoration and refurbishment of service user accommodation. The development of en-suite facilities in service user accommodation The creation of a dining room. The purchase/provision of new hoisting equipment. The installation of a new nurse-call system. The development of a hairdressing amenity. Partial refurbishment of kitchen. The director also spent time explaining several of the company’s future plans for the home, which should further improve the facilities for patients, relatives and staff, including: • • • • • The continuation of the redecoration and refurbishment programme. Alterations to bathing facilities to improve access. Plans to redevelop parts of the premises to increase existing room dimensions and size. The creation of new sluicing facilities. Training room and office. It was evident from comments made by both the patients and their visitors that the improvements being made to the home are appreciated, with the addition of the dining room very popular, as it provides both a communal dining area and a facility that can be used for socialising purposes. One person’s comment encapsulated the mood of the home, in as much as they felt without the intervention of the new owners the home would have continued to struggle and things around the home not improved. An area of the home’s day-to-day operation which was a little disappointing, given the drive to improving services for patients, was the cleanliness issue, with it evident that domestic staff do not take time to address areas of the home above head or shoulder height. When raised with the company director, it became apparent that problems are being encountered because the domestic staff team are reluctant to take on high dusting, etc. for fear of injury. Bluebell Nursing Home Version 1.10 Page 20 This dilemma, however, should not pose a long term problem as provided risk assessments are completed, appropriate equipment supplied and training issues addressed the domestic staff should have no cause for concern and therefore should be in a position to address this area of the home’s cleanliness. From the perspective of the patients, cleanliness did not appear to be an issue, with one person describing the domestic staff member working along their floor, as ‘a gem’. The amount of ongoing redevelopment work could also account for some of the increase dust evident around the home, although given the layers visible this would only account for a fraction of the dust seen. Bluebell Nursing Home Version 1.10 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 30 The new proprietary company has increased the numbers of staff on duty across the three-shift pattern it operates to ensure the needs of the service users can be met appropriately. The position of training officer has been created by the management to address the ongoing educational and vocational training needs of the staff, although presently insufficient time is being used on developing training tools, schedules and monitoring systems. EVIDENCE: The new owners and management team have addressed the issue of staffing, which was a concern under the proprietorship of the previous owners and have increased staffing levels across the three-shift pattern they operate, leading to: a.m. p.m. 2 Qualified and 8 Auxiliary staff on duty. 2 Qualified and 6 Auxiliary staff on duty. Nocte 2 Qualified and 3 Auxiliary staff on duty. In addition to the care staff employed the home also employs catering, domestic, administration, ancillary, maintenance and laundry personnel. Bluebell Nursing Home Version 1.10 Page 22 Staffing rosters were used to evidence the increase and deployment of staff at Bluebell, the management was also able to produce a copy of staff guidance information produced by a previous regulatory body, which indicates that staffing levels are provided in accordance with a prescribed level. In discussions with patients, relatives and staff a mixed picture was painted with some service users, relatives and staff aware of the increased numbers of personnel working within the home and other service users holding to a view that care staff are still very busy and reluctant to bother them unnecessarily. One example of this came during a conversation on the second day of the inspection, when a patient was putting off using the nurse-call system to summons staff, until after 2.00 p.m. as it was felt they deserved a break to have some lunch, as they are always so busy. Training is an issue which has been raised throughout this report and is an issue which requires some attention, although this is not to deflect from the efforts already made by the new company to improve access to educational and vocational training events. However, the creation of the training officer’s post will only be successful if the training officer uses the time set aside for her to develop programmes and training schedules and can use that time for that purpose and is not required to support care staff in the delivery of care. During the two days spent in the home it was apparent that attention should be given to getting the basic elements of care right (for some staff) before moving on to more complex and challenging issues. The need to reinforce for staff that dignity and respect must be promoted for people at all times is of paramount importance, as people should not enter a room without knocking and waiting for a reply, the cessation of the practice of tipping wheelchairs occupied by service users must be undertaken immediately and the reinforcement of moving and handling skills raised. On a more positive note is the construction or creation of a new training office/room, the previous training room altered to provide en-suite accommodation for service users. The new facility should provide the training officer with a dedicated base from which to plan and provide educational events for staff. The staff themselves seem to appreciate the efforts being made by the new proprietary company to increase training opportunities, which previously they described a scant and of little value. The induction/foundation programmes available are based on Skills for Care guidance, which should ensure that any new staff member recruited is suitably prepared for the role they are undertaking, although again the quality of any
Bluebell Nursing Home Version 1.10 Page 23 induction programme, etc. is only as good as the time and effort put in by both the new member and trainer, ensuring that competence is assessed before signing a unit off. Bluebell Nursing Home Version 1.10 Page 24 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36, 38 The new company has yet to introduce a formalised supervision programme for staff and at present utilise an informal process for monitoring and supporting staff. The management’s approach to health and safety is reasonable, although some areas of practice require addressing to ensure all parties accessing the home, using equipment or relying on aids for transport, etc. remain safe. EVIDENCE: Discussions with key staff, including the manager/matron and training officer revealed a situation whereby nursing/care staff working at the home are inadequately supervised, a structured supervision programme having yet to be devised and implemented. An informal process of supervision is said to exist, with senior staff available to support and guide junior staff, although evidence from the inspection, already raised in the body of this report, suggests that care staff have some badly
Bluebell Nursing Home Version 1.10 Page 25 ingrained practices which require addressing through training, development and a more formalised supervision programme as they are not being appropriately addressed currently via the informal procedures that exist. Health and Safety was observed to be another area of the home’s operation where the efforts put in by the new company and the new management team has yet to realise its full potential. Individualised risk assessments are undertake with each patient and any area of their day-to-day life that poses a potential threat to their wellbeing is identified and addressed through a risk reduction plan, copies were present on each care planning file reviewed. Efforts have also been made to reduce the impact of environmental risk on both the service users and staff, with floor coverings replaced, new equipment purchased, dangerous items stored appropriately, data sheets obtained for COSHH materials and an emergency call option on the new nurse-call system introduced. However, these actions have to be weighed up against failures to address all noticeable health and safety issues, hoist slings that appeared to be frayed and damaged, an unmarked lip at the start of a carpeted ramp, infection control risks posed by poorly cleaned equipment (hoists, wheelchairs) and heavy dustcovered areas of the premises and the actions of staff in transferring service users in wheelchairs without footplates that they tip back to overcome obstacles. However, given these observations and comments it is worth noting that throughout conversation with service users and visitors alike, no issues involving concerns for their general safety were raised and that by and large people appear very happy and content with the service they receive from the new proprietary company. Bluebell Nursing Home Version 1.10 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x 3 3 x x x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x x 2 x 2 Bluebell Nursing Home Version 1.10 Page 27 no Are there any outstanding requirements from the last inspection? 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 St 22 Regulation Requirement Timescale for action 18.05.05 2. St 22 3. St 26 Regulation Footplates supplied with 13 wheelchairs should be used when transferring service users. Where footplates are not suited to the individual, arrangments should be made for a appropriate assessment of that persons needs to be made. Regulation The management should 18.05.05 23 undertake regular reviews of hoist slings, etc. to ensure they are fit for purpose / undamaged and safe for use with service users. Regulation Risk assessments must be 18.05.05 23 undertaken on the role of the domestic staff and cleaning of areas of the home above head height. This should enable the domestic staff team to clean those areas of the home, which currently are heavily dust covered. Arrangements should also be made for hoists and wheelchairs to be cleaned and dust and debris removed. Bluebell Nursing Home Version 1.10 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard St 10 St 12 St 30 Good Practice Recommendations The importance of knocking on doors and awaiting replies before entering rooms should be discussed with staff and monitored. The new activities co-ordinator should be given sufficient time to generate a comprehensive and full schedule of entertainments for service users. The newly appointed staff training officer should be given sufficient time and resources to produce a training plan based on the needs of the staff team. The training officer should also consider how the hours staff spend training is to be evidenced and detail when training update dates are approaching. A formalised programme of staff supervision should be introduced, enabling the manager to address such issues as training, the ethos and values of the home and practice issues affecting staff performance, etc. A lip at the start of a second floor ramp should be highlighted, in order to reduce the risk of trips, etc. for people required to use this route. 4. St 36 5. St 38 Bluebell Nursing Home Version 1.10 Page 29 Commission for Social Care Inspection Mill Court Furrlongs Newport PO30 2AA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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