Inspection on 06/08/08 for Bluebell Nursing Home

This inspection was carried out on 6th August 2008.

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

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

Other inspections for this house

Bluebell Nursing Home 25/02/09

Bluebell Nursing Home 26/02/08

Bluebell Nursing Home 10/07/07

Bluebell Nursing Home 30/05/06

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Bluebell Nursing Home 45 - 53 St Ronan`s Road Southsea Hampshire PO4 0PP Lead Inspector Anita Tengnah/ Carole Payne Unannounced Inspection 10:30 6 August 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bluebell Nursing Home Address 45 - 53 St Ronan`s Road Southsea Hampshire PO4 0PP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 023 9282 3104 023 9282 6109 suecollins@whnh.com Techscheme Ltd t/a Bluebell Care Home Vacant post Care Home 51 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0), Physical disability (0) of places Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Physical disability over 65 years of age (PD) 2. Dementia (DE) maximum number 15. The maximum number of service users to be accommodated is 51. Date of last inspection 5th June 2008 Brief Description of the Service: Bluebell Nursing Home is registered with the Commission for Social care Inspection (CSCI) to provide nursing and personal care to 51 people in the older person category. The home is situated in Southsea and is close to the pier and seafront, a predominant feature of the area, which is well serviced by local bus companies. Local facilities are sparsely situated, although Southeas main shopping centre is a short journey from the home. The nursing home is comprised of five period town houses combined to create a single building, with three separate floors and two mezzanine floors. The home has a small garden to the back with seating provided. The current fee charged is £521-£777 per week. Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience Adequate quality outcomes An unannounced visit to the service was undertaken as part of the inspection on the 6th August 2008. The process included a tour of the service where a number of the bedrooms, communal areas, laundry and bathrooms were viewed. As part of case tracking staff and service users views were sought and care records were looked at. We sent out our Annual Quality Assurance Assessment to the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. This is included in this report, as was information gathered by the Commission as was information gathered by the Commission since the last inspection to contribute in assessing judgements in this report. We also undertook a random visit to the service in June 2008 to follow up on a Statutory Requirement Notice and reference to this will be reflected in the body of the report as appropriate. The acting manager and a number of staff assisted us with the inspection. What the service does well: What has improved since the last inspection? The complaint log has been developed and made available. The statement of purpose had been recently reviewed and updated. The home has employed an activity coordinator since the last visit. There is a moving and handling assessment in place to demonstrate how the needs of the service users will be met. An activity plan for the residents has been developed. Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 6 The acting manager is in the process of introducing a wound assessment/ care plan for the service users. There has been some improvement in the training programme available to the staff. There has been an improvement in auditing of care and staff supervision. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 1,3,6 Information in the statement of purpose was available to the service users. A preadmission assessment format has been put in place. We were unable to make an assessment on this occasion, as the home has not admitted any new service users since the last key inspection. The home does not provide intermediate care. EVIDENCE: We looked at the information available to prospective service users in order to help them make an informed choice. The service has since the last inspection developed and updated their statement of purpose that included the name of the new responsible individual as required. A copy of the document was available in the entrance hall. Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 9 The acting manager stated that the pre admission assessment documentation has been updated to include all the information required. We did not assess this standard on this occasion, as the responsible person has confirmed that there has been no new admission to the service since the last two visits. The staff confirmed that the service continues not to provide intermediate care. Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is Adequate This judgement has been made using available evidence including a visit to this service. The care plans, records of care and access to external healthcare have showed some improvement, however would benefit from further development to protect people using the service. Medication management has improved and continuous audit and appropriate recoding must be sustained. There has been some action taken to ensure that people are treated with respect. EVIDENCE: We looked at a sample of four care plans as part of this visit. We found that Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 11 The care plans contained some assessments such as falls, continence and dietary needs that have been put in place since the last visit. We noted that a number of the residents had fluid/ food charts introduced following their dietary needs assessments. Records showed that some improvement in the recording of their diets during the day has been achieved. The concerns remain about the lack of record maintained in particular for the evening and night times. The records for two of the service users showed that there was a gap of between 8-14 hours where they had not received any diet/fluids according to records. These are similar concerns that we raised during our random visit in June 08 that has as yet not been fully resolved. During this visit most residents had drinks that were accessible to them. One resident had a drink but their lips were dry and sticky, another resident could not access their drink. The care plans would benefit from further developments so that they contain accurate details of the residents assessed needs, person centred and action on how these would be met. We noted that there was no care plans relating to the personal care needs of people in the records we looked at. However care had been taken in giving residents personal care. One resident said that she looks forward to having a bath each week. Care had also been taken with dentures, nails and hair for those residents we met. There was some evidence that moving and handling assessments were completed and details of the actions required were available in the care plans seen. The staff we spoke to said that they had been instructed that those residents who require hoisting must have two staff. During the random visit in June 08 we looked at four-wound care plans of the service users who were receiving treatment to their pressure ulcers. The wound care plans contained details of the wound treatment needed and frequency of dressing to be completed. There were some evaluations of wounds completed but this was not consistent. The care plans did not contain details of wound size and grading. During this visit the wound care plans seen indicated that information in them was variable. Some had clear plan of action about the wound care needs of people, and record of dressings changed/ wound review. However one care plan for one of the service users showed that the skin integrity and pressure areas were intact but a second care plan showed that the service user had dressings to his legs. As discussed the wound care plan needs further development to include the wound grading and size of wound. The wound care plan must be reviewed to ensure that it contains up to date information about the current treatment, as this was not available in the wound care plan seen. This showed that the service user was receiving a different treatment than the care plan indicated. Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 12 The staff reported that a different wound care plan had been introduced and they are planning to replace all the wound care plans to the new format. This looked comprehensive in terms of addressing residents’ needs. One resident was noted in the care records to have a trace of protein and blood in their urine on 12/07. There was an entry in the diary to re-test the person’s urine. There was no record that the deputy manager could find that this had been carried out. On 5/08/08 it was noted that the person was experiencing further problems. There was again no record of action taken and this was brought to the attention of the deputy manager at the time of the inspection, as there remained a health issue. The deputy manager decided to call the GP. The acting manager reported that the residents were registered with the local GP practices. They received care from the local surgeries as requested. Access to other healthcare team was available to the residents as required. One of the residents was referred to an external healthcare professional for a swallowing assessment in the care plans that we looked at. One service user had a diabetic care plan. This was a generic plan and had not been adapted to reflect the needs of the individual. One resident said that they had been told they were diabetic; the senior nurse said this was borderline. The deputy matron said that they had had a high blood sugar reading and were being monitored twice a year. The resident was upset about this and not clear about their health care needs. We noted that although staff identified some of the people’s needs, these were not always followed up to ensure that these needs are met. This included one of the residents identified as risk of choking and requiring thickening agent in his diet. We looked at how the home was ensuring that the residents’ privacy and dignity was being respected and the associated care practices. On the 5th June 2008 the commission carried out an unannounced visit. We noted that the staff when transferring one of the service users in the lounge used a mobile screen in order to protect their privacy. However we observed another service user who had just been served lunch by one of the carers in her room and whose dignity was not protected. This was brought to the attention of the person in charge to take action. From records seen during this visit training for staff has been implemented, which included consideration of the values of good care practice. This has been undertaken individually with staff so that the training is tailored to meet the needs of the individual. Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 13 During the visit staff were observed addressing service users in a respectful manner. We observed that in the rooms we visited screens were available to protect the privacy and dignity of people using the service. We also noted that a care plan relating to personal care for one of the residents were displayed on their bedroom wall. This was brought to the staff’s attention, as this does not respect their privacy. The acting manager also produced records relating to how the home sets out to protect the privacy, dignity and rights of people living in the home and this is discussed with all members of staff, as part of the service’s ethos of care. Residents’ laundry is kept in individual baskets, prior to returning to service users’ room. Clothes are labelled so that they are returned to the resident to whom they belong. One resident said, “staff are mostly kind, apart from one”. Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an action plan to improve the social activities for people using the service. The visiting policy supports people to maintain contacts with their relatives. The meals at the home were well-managed and offered choices that met with their satisfaction. EVIDENCE: Following the last inspection the registered person was required to ensure a system is in place to provide all service users with opportunities to take part in a suitable programme of activities and stimulation based on their needs, wishes and preferences. The random visit in June 08 showed that since the last inspection the number of staff hours allocated for activities had increased. There was some recording Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 15 in individual residents’ records for participation in activities. However these were not consistent in all the documentation seen. During this visit we noted that a social history was available in two of the care plans seen. There were some records in individual files of participation in social / recreational activities in the home. The records of activities again as previously noted were variable and did not fully demonstrate how the individual’s needs are met. The responsible person said that activities had not been recorded as one of the staff had been off on sick leave. Since the last inspection the home has employed an activities’ co-ordinator, on the day of the visit, she was seen spending one to one time with a resident. The activities co-ordinator had a lot of ideas about future activities, to improve the quality of life for people living in the home. Records detailing future plans were viewed at the time of the inspection. The activities coordinator is working 9:30 to 14:30 four days per week. The acting manager reported that a member of the care staff team also devotes four to six hours a week to providing activities in the home. An entertainer comes into the home each week. One resident said that they look forward to this. Arts and crafts and visits from representatives of local religious denominations are part of the daily life of the home. One resident said that they liked the food, “it is good.” They said that they didn’t have a choice but could say that they didn’t want any food prepared. A varied menu was seen. One resident said that there was “not much going on in the home.” Another said that there were not many people currently at the home, who were able to communicate with them. On the day of the visit there was appropriate music playing in the lounge. Residents in this area were enjoying listening to the music. During the visit staff could be heard chatting with service users in their rooms and in the communal areas. A resident said that their relative visits each day. There was reference to next of kin; contact details and communication with families in care records seen. A resident said that she was disturbed by noise from another room, during the day and at night. The deputy manager said that consideration had been given to moving a resident, so that this person could experience a quieter environment of choice. Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The process for the management of complaints is adequate, with records of complaints/ investigations and outcome now available. Staff training in safeguarding is being developed to protect people living in the home. EVIDENCE: Following the last key inspection the provider was required to put in place a complaint log to demonstrate how the home was managing complaints/ concerns raised at the service. We noted that this had been put in place during the random visit in June 08. The complaints procedure is written clearly and contains up to date information. The procedure is made available in the statement of purpose, which is within the service user’s guide in the reception area of the home. The home now maintains a log of complaints received and details actions taken and outcomes. The home does not yet have a copy of the up to date safeguarding protocol from Social Services. Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 17 The acting manager stated that recent training in the service has focused upon the protection of vulnerable adults. No records were seen of staff who had completed the training, there was a record of people who still needed to complete it. Following the last key inspection we have received three complaints about care practices at the service. These contained allegations that affected the welfare of people accommodated and had been referred to social services as part of safeguarding. We received a further concern following this visit and again have referred to safeguarding. From the evidence above and staff spoken with, there is an indication that staff do not feel able to raise their concerns to the home. Comments from staff included: “we are told to get on with it”. “The seniors don’t know what is going on”. Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The ongoing refurbishment provides the residents with a comfortable accommodation. The laundry is well managed and the infection control procedures are satisfactory. EVIDENCE: On the day of the visit all areas of the home visited were clean. Comfortable furnishings are provided in rooms and those visited had been personalised by the resident, and, or, their family. However some rooms were bare and in one bedroom wall pictures were left on the floor. The provider must ensure that the residents are provided with assistance in personalising their rooms according to their choices. Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 19 One of the residents commented about their room that had been recently refurbished and ”the lovely flooring”. The room was bright and airy with plenty of room to manoeuvre and wheelchair access as required. The laundry area is well organised. The home has three washing machines and two tumble driers, which was adequate to meet the needs of the service at present. We noted that the residents’ rooms we visited had call bells in place. One resident said that a member of staff regularly takes their buzzer away and puts it on the bed. This was brought to the attention of the management and must be looked into. Records of staff meetings showed that staff responses to requests for assistance had been discussed and methods of improving responses implemented. Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing was adequate to meet the present needs of people accommodated from the records seen. The recruitment process does not fully ensure that all checks are completed prior to employment for the safety of people living in the home. The record of training for staff has improved. The lack of mandatory training in health and safety does not fully protect people accommodated. EVIDENCE: We looked at a copy of the duty roster as maintained at the home. On the day of the visit there were two registered nurses, ten carers and other ancillary/ kitchen staff on duty that supported the carers in their role. There were mixed responses to whether the home had adequate staff to meet their needs. Comments included ”it depends who is working”. One service user said, “usually you don’t have long to wait”. Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 21 The staff said that “ we are always rushed to get things done”. Since this visit we have received concerns relating to the staffing level that we have referred to social services as safeguarding. Recruitment records were viewed for three staff members working in the home. Appropriate checks had been taken including Criminal Records Bureau checks and checks of the protection of Vulnerable Adult’s list prior to starting work. We discussed with the responsible individual that the manager had been employed without a CRB clearance and there was no system in place to supervise her. We noted that a record from the duty roster showed that she was planning to work on night duty on the day of the visit. Following the random visit in June 08, training for staff has been implemented, which included consideration of the values of good care practice. A record of induction was seen for a member of care staff, who had recently started working in the home. The record is interactive, with the staff member answering questions to confirm understanding. The record for induction looked detailed and was dated 2006, it was not, therefore, possible to clarify if this meets with current Skills for Care guidelines. During the visit a member of staff brought in a completed workbook. The training officer said that these are marked externally and cover all areas of mandatory care practice. A training record was seen for a Registered nurse. The member of staff had completed mandatory and clinical training in the past year, to ensure that they maintained the skills that they need to provide care according to the needs of residents and fulfil their requirement to remain on the register of the Nursing and Midwifery Council. Copies of certificates were seen on file. The deputy manager said that she has completed a course in dementia mapping, and hopes to use the skills that she has learnt to improve the quality of life for people who have dementia living in the home. The training officer said that they did not have a training matrix, although the responsible individual said that there was a matrix in place and submitted a record for fire training undertaken by staff, following the inspection. The training officer said that he intends to use a diary to plan training, which is on order. There is a whiteboard in the training room, where the training officer maintains a list of members of staff needing different training courses. Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 22 The training officer works Monday to Friday 8:00 to 14:00 and also undertakes some care work. He said that he is also a qualified first aid instructor. He confirmed that two members of the management team were also qualified moving and handling instructors. There is an annual training programme in place, which details courses booked until the end of the year. Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a new manager in place. The acting manager will require registering with the Commission. An audit of care delivery has commenced. This needs to be sustained. The health and safety of the service users are not always fully protected. Further action is needed and records of training must be available. EVIDENCE: The service has recently recruited a manager who will have day-to-day management responsibility of the home. The acting manager is a registered Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 24 nurse and has recent experience of working with the elderly. From discussion with the acting manager there are plan to develop the way that care is delivered. These included reviewed pre admission documentation and wound care plans. The registered person must ensure that the manager is supported to develop/ implement her own strategy in managing the service. As reported in the previous section, the responsible individual was aware that the manager had been employed without a CRB clearance and there was no system in place to supervise her. We were unable to assess how the acting manager would be carrying out her responsibilities and accountability as she has been in post for a short time. The registered person had written to us in June 08 that the manager would be applying to register with the commission following a month’s probation. An application must be submitted, as we have not as yet received this. Following the last inspection the service was required to have in place a structured supervision programme. We also reported that there was some confusion about who undertook this. During this visit we noted that the Registered nurses have started to carry out supervision in the home. Recent records were seen of supervision sessions completed. The registered person must also retain records of checks for trained staff to demonstrate that they are on the current nurses register, as this was not available, although the responsible individual confirmed that the checks had been undertaken, there was no evidence of this kept on file. The home completed a quality assurance exercise in April 2008. The results of surveys have been brought together in a report detailing action taken as a result of the outcomes. Recent records were also seen of staff meetings, which documented the feedback of staff about what it is like to work in the home and how outcomes can be improved for people living in the service. Audits are also used by the service to assess how the service is performing and can improve. Staff reported that audits are carried out of medication handling practices and falls. The fire log was seen. Weekly fire alarm checks had been undertaken. Fire doors, including magnetic door releases had not been checked since May 2008, and a visual check of fire extinguishers had not been undertaken since the end of May. The responsible individual advised that staff were now in place to ensure that checks are completed at the required intervals, to promote the safety of everyone living and working in the home. The records seen did not demonstrate that staff fire training included fire drills as required. The registered person must ensure that these are in place to ensure the safety of people using the service. Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 25 There was no risk assessment for the building and risks assessments of the residents with limited mobility/ wheelchair users who are accommodated on the top floor were not available. The responsible individual confirmed that these had not been completed. As reported in the complaint section, staff have raised concerns regarding alleged poor moving and handling practices due to lack of staffing. The registered person must ensure that systems are in place to ensure the health and safety of the residents is protected. Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1) Requirement The registered person must ensure that new service users are only admitted following assessments. The service users must be provided with confirmation that the home is able to meet their needs following assessments. The registered person must ensure that following assessments detailed care plans are put in place to demonstrate how the service users’ assessed care needs would be met. Evidence of the service users / advocates participation in the formulation of care plans must be available. The registered person must ensure that the service users health and personal care needs are fully met at all times. The registered person must ensure that detailed care plans; assessments and reviews are in place for the treatment of pressure ulcers. DS0000062757.V369018.R01.S.doc Timescale for action 15/09/08 2. OP7 13(4) 15 (1) 15/09/08 3. OP8 14(1) (a) Schedule 3 (o) 17(1) (a) Schedule 3(p) 15/09/08 4. OP8 15/09/08 Bluebell Nursing Home Version 5.2 Page 28 5. OP9 13(2) The registered person must 15/09/08 ensure that arrangements are in place for the safe handling, safe administration, recording and disposal of all medicines received into the care home. This must include prescribed wound dressings. The registered person must ensure that all medications prescribed are recorded on the MAR sheets and records of these are maintained. The registered person must ensure that all necessary checks are in place prior to employment including CRB. An application for the acting manager to be registered with the Commission must be submitted. The registered person must ensure that the service users are not put at risks and all staff complete mandatory training in health and safety. Records of these must be available. 15/09/08 6 OP9 17(1) (a) Schedule 3 (k) 19 (1) 7 OP29 15/09/08 8 OP31 8,9 15/09/08 9 OP38 13(5) 23(4) 15/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bluebell Nursing Home DS0000062757.V369018.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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