Inspection on 21/08/07 for Bluebells

This inspection was carried out on 21st August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bluebells 27/07/06

Bluebells 12/10/05

Bluebells 11/04/05

Bluebells 07/10/04

Bluebells 01/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Bluebells 152 Moredon Road Swindon Wiltshire SN25 3EP Lead Inspector Bernard McDonald Unannounced Inspection 21 August 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bluebells DS0000003169.V339648.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. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bluebells Address 152 Moredon Road Swindon Wiltshire SN25 3EP 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) 01793 611014 08708318894 Mr Abitalib Ebrahimjee Position Vacant Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th July 2006 Brief Description of the Service: Bluebells is a large bungalow in the Moredon area of Swindon offering accommodation and care to 16 older people. The home is close to local shops and services and on a bus route. The home offers a mixture of double and single rooms. There is an open plan area incorporating two lounges and a dining room. These rooms can be used for social and religious activities. The sitting rooms are smoke free. There is wheelchair access to the garden and there were two ramps. There is seating in the garden in the form of plastic benches and chairs. Lighting is domestic in style. The home offers long term care and occasional respite care. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place over three days for a total of twentythree and a half hours. A tour of the building was made and all areas of the home including a sample of people’s bedrooms and communal living areas were seen. We met with the majority of people who use the service and had opportunity to speak to a number of people in private to obtain their views on the service they receive. In addition six members of staff and four visitors to the home were spoken to in private. As part of our inspection, comment cards were sent to people living at the home, their representative’s, health care professionals and placing authorities. Other information was obtained from The Annual Quality Assurance Assessment (AQAA), which had been completed by the home and sent to the Commission during the inspection. Five care plans were examined in detail. In addition medication records, staff recruitment files, training records, health and safety documents and a sample of risk assessments were also examined. The Commissions pharmacy inspector reviewed a sample of records and administration of medication. Feedback on the preliminary findings was given to the provider at the end of our site visit. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: We found people using the service were generally satisfied with the care provided in the home. Visitors we spoke to during our site visit were satisfied with the care their relative was receiving. People using the service are able to maintain contact with people who are important to them. People’s religious needs are identified. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 6 People are able to visit the home prior to admission and information to inform the person about the home is being updated. What has improved since the last inspection? What they could do better: The standard of recording needs to be improved to ensure the needs and safety of people living at the home is protected. Where specific care needs and intervention is required, the input provided by staff needs to be clearly recorded to demonstrate that the care has been provided to ensure the needs of people using the service are being met. The home must ensure all staff have opportunity to read and understand people’s care plans. This is to ensure staff are fully aware of people’s needs and the support they require. Records of meals served at the home make it difficult to demonstrate whether people receive a varied and nutritious diet. On one site visit to the home we found no food suitable for diabetics. We found no specific care plans for people with diabetes, which places people at unnecessary risk. The management of complaints needs to be reviewed to ensure all complaints are responded to as specified in the homes complaints procedure. We found personal information on people using the service was not being held securely. People living at the home and also visitors to the home could access these records. The Commission is concerned that staff working at the home are not ensuring the safety and wellbeing of people. The failure on the part of staff in not using the safeguarding policy leaves people using the service at risk. The recruitment and induction of staff needs to be improved to ensure the health, safety and welfare of people using the service. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 7 We found staff working excessive hours i.e. 24 hour shifts, leaving people using the service vulnerable from tired care staff responsible for their care. Moral amongst staff is low. The staff team do not feel supported by the manager. Quality assurance needs to be improved to ensure the service is being run in the best interest of people living at the home. 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. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5, 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service have their needs assessed prior to moving to the home but the quality of recording and content of the information was limited. Opportunities are being provided to enable people using the service to visit the home before deciding whether to move in. EVIDENCE: The records of two people admitted to the home since our last key inspection were examined in detail. Documentation has been updated since the last visit to the home. One person had a copy of the in-house assessment of need, which had been completed by staff. This is a comprehensive document covering health and personal care needs. The document had not been signed or dated to indicate when the assessment had taken place. The document is split into two parts; the second section to be completed on admission had not been filled out. The manager confirmed a full assessment had also been received from the persons placing authority. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 10 Examination of records showed a care plan for the person had not been developed for three months. This is considered poor practice. The person’s relative came to visit the home prior to them moving in. The second person admitted to the home had a comprehensive community care assessment completed prior to moving in. The person and their relative confirmed they had visited the home prior to making a decision to move in. The person using the service confirmed they were, “very happy” with the care they received. The relative of the person also confirmed they were happy with the care and had “no complaints”. The home had developed an interim care plan for the person, which identified the risks associated with falling and pressure damage. The manager and provider are currently updating the statement of purpose and service user guide to reflect the changes at the home, a copy must be sent to the Commission once the documents have been completed. The home does not provide intermediate care. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans do not fully reflect people needs and risks associated with their care are not being safely managed. Systems are in place for the safe handling of medicines, however records of variable doses should be clearer. People are not always treated with dignity and respect. EVIDENCE: The care records of five people were examined in detail, including two people recently admitted to the home. Since the last key inspection new documentation has been introduced to the home to record the needs of people using the service. The care plan now covers all areas of personal care including maintaining a safe environment, communication, continence, eating and drinking, expressing sexuality, sleeping and dying. We found that not all parts of the care plan had been completed. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 12 It was reported that the new system has only been implemented in the past two months. However the information contained in the care plan of one person was confusing. The care plan identified the person was at high risk of malnutrition and the action required of staff was to monitor food intake. A fluid and food intake chart is in place but no directions on how much fluid the person should have. There were numerous gaps in the records for example on 23/07/07 the records show the person had no breakfast or lunch and only three jam sandwiches and a packet of crisp all day and no meals at all on 5/8/07 and 6/8/07. The same poor standard of recording was also found in the fluid intake charts, which for example showed no fluids taken on 27/7/07 no fluids taken after 1.00pm on 17/8/07 and no fluids given from 1700 hours on 22/7/07 till 1500 hours on 24/7/07. From the records available it was difficult to evidence if the person was receiving a balanced and nutritious diet. The care plan of one person showed a risk of malnutrition. Records demonstrated the person had a score of 0 for weight loss, which means the person had lost no weight. The records indicated the person had been weighed on 29/6/07 and again 29/7/07. However discussion with one member of staff confirmed the home had no scales and the person had not been weighed “for a while”. The practice of completing records without having undertaken the task i.e. weighing the person, puts people using the service at serious risk and is a practice that must stop. On the third day of our site visits a new weighing chair had been purchased. There is evidence that care records are being updated, however when care plans are reviewed or updated staff are not being made aware of the changes. For example one person’s care plan had been updated and in discussion with the persons key worker it was evident that they were not made aware of the changes. One person’s care plan identified they were at high risk of falls. There was no evidence to demonstrate how the risk had been identified. The person was mobile and discussion with three care staff confirmed they would not consider the person to be at risk. Care staff commented that the care plan system was difficult to follow. In discussing the needs of one person with a senior member of staff, the staff member was not aware of a specific care issue about the person and how this has to be managed. The care plan did contain information about the care issue but gave no direction to staff on how to meet this need. The person was diabetic which was controlled by tablets and diet. There was no care plan about the specific diabetic needs of the person. The care plan made reference to measuring blood sugar levels and the care plan stated this is not required. Discussion with the person using the service confirmed they did have their blood sugar levels checked and showed the inspector a small book in which they recorded the level. Discussion with staff confirmed no one had been trained in taking blood sugar levels. The representative of the provider was informed that they should seek the advice of the district nurse to address this shortfall as a matter of urgency. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 13 The AQAA we received stated that health care needs that require specialist attention are referred via a GP to an appropriate health care professional. Evidence gathered during our site visit would indicate this is not happening for all people who use the service. However there was evidence of good practice in the care of one person whose health care needs had deteriorated. The relative of the person stated that they “could not fault” the care provided to their relative. The person also commented that staff “looked after” them. New equipment had been obtained to assist with manual handling and during our site visit the Occupational Therapist was visiting to assess one person. The Pharmacist Inspector looked at arrangements for the handling of medicines. Medicines are stored securely and appropriate records are kept. Printed medication administration sheets (MAR) are used and additions are signed by two members of staff. Some doses of a particular medication may have been signed for and not given, this was picked up by the home’s auditing process and reported to the Commission. The manager showed how this had been addressed. Medicines prescribed with variable doses (for example those prescribed for constipation or irregular pain relief) should have clear protocols to determine which dose is given, agreed with the prescriber or nurse. Where the dose is determined by a blood test, the dose must be written on the MAR as well as in the booklet. Some medication may be stored in the office, which has limited access; if this is the case a procedure for gaining access to this medication must be produced. Following the pharmacy inspectors visit the practice for administering medication had changed. Staff reported that one person dispenses the medication and signs the medication record and another member of staff is sent to administer it. This is considered poor practice and staff should not sign for medication they have not administered. Discussion with people who were able to give their opinion, confirmed they were happy with the care provided at the home. However some care practices that were observed demonstrated that people are not always treated with dignity and respect. For example on the first day of our visit we observed one person sat in one of the communal areas ‘crying out’. Other people living at the home were complaining about the noise, staff did not attend to the person until the inspector asked them as it was reported the person is normally like this. Another person had their meal left in front of them for a period of twenty minutes before being given assistance by which time the meal was cold. We found the notice board in the main hallway contained personal information about people living at the home. In addition the care plans and personal notes of people living at the home were held in an unsecured desk in the hallway. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 14 Not only people living at the home but also visitors to the home access this area. This was brought to the attention of the representative of the provider who arranged for the information to be removed. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service are able to maintain contact with people who are important to them. People’s religious needs are identified however opportunities to exercise choice are limited. Records of meals served at the home make it difficult to demonstrate whether people receive a varied and nutritious diet. The lack of diabetic food stocks leaves people at risk EVIDENCE: One member of staff is responsible for organising activities in the home. Discussion with the member of staff confirmed there is an activities programme in place, which they work through. It was also reported that the home has purchased games and activity equipment for people to use. Observation made during the three days of our site visit found there was little interaction between staff and people using the service other than completing personal care tasks. However on the third day of our site visit people using the service confirmed they had just completed gentle exercises, which they said they enjoyed. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 16 In addition staff reported that every Thursday some people using the service help out at a tabletop sale and the proceeds raised are shared between local charities. People using the service stated, “there is nothing to do”, and “I would like to go out to the shop”. Records of activities being provided in the home were limited in detail and frequency. People’s religious preferences are recorded and one of the local clergy visits the home every month. People do have a choice on whether they wish to attend the service. Discussion with relatives who were visiting people and feedback from comment cards that we sent to relatives confirmed they could visit the home at anytime. Information provided by the home in their AQAA stated “all residents are encouraged to maintain current relationships”. The home does not act as agent for people’s finances. This responsibility remains with the person using the service, their family member or legal adviser. The home has however started holding money on behalf of people and this is commented on in standard 35. The record of meals served in the home is poor. For example on 26/8/07 the records show no lunch was provided and on 28/8/07 no tea or supper was provided. There is no record of special diets being provided for people who are diabetic. Examination of the food stocks in the home showed the cupboard and freezer were sufficiently stocked. However we were concerned to find there was no low sugar or diabetic food stocks in the home. This was brought to the attention of the representative of the provider and staff were immediately sent to purchase the necessary items. Care staff are preparing and cooking meals at the home although a new cook had been appointed and was awaiting the necessary recruitment checks before commencing work. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 17 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 poor. This judgement has been made using available evidence including a visit to this service. People using the service are not protected by the homes safeguarding procedures. The investigation of complaints needs to be improved. EVIDENCE: The home has a complaint procedure, which is displayed at the entrance to the home. Comments received from relatives confirmed they were generally aware of the complaints procedures. The Commission has completed two random inspections of the home following complaints made directly to the Commission. The home has also received a number of complaints some, of which have not been investigated to the satisfaction of the complainant. In particular one person made representation to the Commission because they had not received a response to a complaint they had made. This has now been addressed. Information supplied in the AQAA states the home has received eleven complaints in the past twelve months and only one complaint has been upheld. Policies for the protection and safeguarding of people using the service are in place. Records examined showed that the majority of staff have completed abuse awareness training. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 18 However since our last key inspection there have been serious safeguarding concerns at the home. These incidences have resulted in staff members being disciplined and subsequently dismissed from their employment at the home. It is evident from our inspections of the home that the providers do respond appropriately to safeguarding matters that are brought to their attention. The providers have made one referral to the Protection of Vulnerable Adults register. The Commission is concerned that staff working at the home are not putting into practice the training they have received. For example on the second day of our site visit we were alerted to an alleged incident which several staff were aware of and had not reported. The failure on the part of staff not to use the safeguarding policy leaves people using the service at risk. The safeguarding adults team is currently investigating this matter. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to make improvements to the standard of décor and furnishings for the benefit of people using the service. EVIDENCE: The home is currently undergoing a refurbishment programme. Since our last site visit one of the communal lounges and three bedrooms have been decorated to a good standard. It was reported that there are plans to redecorate all of the bedrooms. In addition new dining room furniture has been purchased which enables all people using the service the choice of eating their meals in the dining room. The laundry room is sited outside of the main home. There is a commercial style washer and dryer, which is sufficient for the needs of the home. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 20 We found the home had red alginate bags to reduce the risk of infection from handling soiled linen. Staff reported that they had sufficient disposable aprons and gloves. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The recruitment and induction of staff needs to be improved to ensure the health, safety and welfare of people using the service. Improvements have been made to the number of staff on duty throughout the day but the excessive hours worked by staff leaves people using the service vulnerable from tired care staff responsible for their care. EVIDENCE: Examination of the rota demonstrated that some staff are working 24 hour shifts. Staff reported that they find these hours excessive and often feel tired at the end of the shift. When staff are working these long hours they normally provide the sleep-in cover at night. If people using the service need extra support during the night the sleeping in staff is used to provide extra help for the waking night staff. Examination of the accident book shows that people living at the home have fallen at night and it recommend that consideration be given to employing two waking night staff. The rota demonstrates there is now normally three staff on duty during the day. The home has been using agency staff to cover some shortfalls in the rota. Since our last site visit eleven staff have left the home. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 22 Information provided in the AQAA states six staff have obtained NVQ level 2 qualifications and three staff are working towards level 3. The recruitment records of three staff recently employed at the home were examined in detail. One person’s records showed that the home had obtained a Criminal Records Bureau (CRB) check and Protection of Vulnerable Adults (POVA) check. The home had obtained two references but the copies held on the file did not state who they had been received from. There was no evidence that induction training had been completed although an induction checklist was on file. There was no medical declaration to say the person was medically fit. The records of the second person did not contain evidence of their full employment history. The employment checklist had been completed to show this had been discussed at interview but we could find no evidence of this happening. The records of the third person were satisfactory. The home has a copy of the ‘skills for care’ induction booklet, though there was no evidence to show this had been completed for the two staff recently appointed to the home. However following discussion with the representative of the provider a copy of an older style induction programme had been partially completed by two staff. The person most recently appointed had not completed any induction programme. The staff member stated, on the day they started work in the home they were “thrown straight into it, providing personal care straight away”. The records show that this person had not been made aware of the fire safety precautions until their second day. The member of staff stated that they still have not had time to read all care plans. All staff have been registered to complete the Certificate in Dementia Awareness. Bluebells DS0000003169.V339648.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): 31,32, 33,35,38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff working in the home do not feel supported. Quality assurance needs to be improved to ensure the service is being run in the best interest of people living at the home. The recording of money being held on behalf of people using the service needs to be improved. EVIDENCE: Since the last key inspection the home has appointed an interim manager through a social care recruitment agency. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 24 The interim manager in currently in a transition period with the provider considering making the appointment permanent. The interim manager has successfully completed the Registered Managers Award and NVQ4 in care. During our inspection we were informed of a practice issue involving the interim manager, which has resulted in the manager, being suspended while the matter is investigated. The majority of staff confirmed the manager is very good with people using the service but staff do not feel they are supported by the manager. Moral amongst the staff team is low. Comments like the management style is “aggressive” and the manager is “not approachable” were made by care staff. In addition two comment cards received from relatives also felt the manager was not approachable. These comments were raised with the provider who needs to resolve this conflict to ensure the care provided to people is not compromised. The home has started to obtain feedback from relatives regarding the quality of care provided in the home. At present only four responses have been received. The representative of the provider confirmed that letters have been sent out again. A copy of the last year’s quality assurance survey was not available in the home. The provider was slow to respond to a request by the Commission to supply information in the AQAA. In addition the provider has made only three visits under Regulation 26 in the past year. To ensure the home is being run in the best interest of people, more detailed attention to the frequency and content of the provider’s quality monitoring visit must be considered. The home is now holding money on behalf of people using the service. Examination of the records of money being held demonstrated that improvement must be made to the standards of recording and ensure that two people sign for all transactions. Risk assessments have been completed for the building and a new fire risk assessment is in place. The fire risk assessment does not identify how the building is to be evacuated at night in the event of a fire and the home needs to ensure it complies with the current fire safety regulations. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 25 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 2 X 2 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 2 X X 2 Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 26 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 15(1) Requirement The registered person must ensure each person using the service has a plan of care for daily living to ensure staff are aware of the needs of the person and how they should be met. The registered person must ensure that where the persons care plan refers to need to record weight fluid and food intake the records are accurate and fully reflect the action required by staff to ensure people’s needs are met. The registered person must ensure that staff are made aware of any changes that are made to the person care plan to ensure that needs of people using the service are safely met. The registered person must ensure that a care plan is put in place for people who have diabetes. This is to ensure the safety of people living at the home. The registered person must ensure that the person signing the medication administration DS0000003169.V339648.R01.S.doc Timescale for action 01/12/07 2 OP7 15(1) 01/12/07 3. OP7 17(1)(a) 01/12/07 4 OP8 17(1)(a) 01/12/07 5. OP9 13(2) 01/12/07 Bluebells Version 5.2 Page 27 6 OP9 13(2) record, also administers the medication to the person it is prescribed for. This is to ensure people receive their medication in a safe manner. The administration of medication with a variable dose must be supported by a protocol for its use. The registered person must make arrangements to ensure that the care home is conducted in a manner that respects the privacy and dignity of people using the service. The registered person must consult service users about their social and leisure interests. Following the consultation the registered person must take action to ensure service users interests are met. This was a requirement at the last inspection and has been partly met. The registered person must keep a record of meals provided to people using the service to enable any person inspecting to determine whether the diet is satisfactory. The registered person must ensure sufficient food stocks are in place to meet the specific dietary needs of people using the service. The registered person must ensure that staff are aware of their responsibilities to safeguard people using the service to ensure any incidents that may affect the welfare and safety of people at the home are reported immediately. The registered person must ensure they receive two written references and a statement that DS0000003169.V339648.R01.S.doc 01/12/07 7. OP10 12(4)(a) 01/11/07 8. OP12 16(2)(m) 01/12/07 9. OP15 17(2) 01/11/07 10. OP15 16(2)(i) 03/10/07 11. OP18 13(6) 08/10/07 12. OP29 19(1)(a) (b) 01/11/07 Bluebells Version 5.2 Page 28 13. OP30 18(1)(c) (i) the person being recruited is medically fit for the position they have applied for before the person commences work at the home. The registered person must ensure all new staff receive induction training that meets ‘skills for care’ induction standards. The registered person must ensure the quality review takes into account the views of service users representatives and staff working at the home. This was a requirement at the last inspection The registered person must ensure the fire risk assessment meets the current fire safety regulations. 01/11/07 14. OP33 24(2)(b) 01/12/07 15. OP38 13(4)(c) 01/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP3 OP9 Good Practice Recommendations The registered person should improve the quality of recording in the in house assessment of need. If medication is stored in the office, a system to ensure that a member of staff on duty has access to it should be available. The home should review their complaints procedure to ensure that any people who may make a complaint are made aware of the outcome of any investigations. The registered person should employ two waking night staff to ensure the safety of people living at the home. The registered provider should ensure staff do not work DS0000003169.V339648.R01.S.doc Version 5.2 Page 29 3. 4. 5. Bluebells OP16 OP27 OP27 excessive hours and the practice of staff working 24-hour shifts should be reviewed. Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South west Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bluebells DS0000003169.V339648.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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