Inspection on 31/07/07 for Bluebirds Nursing Home

This inspection was carried out on 31st July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bluebirds Nursing Home 25/09/06

Bluebirds Nursing Home 10/11/05

Bluebirds Nursing Home 14/07/05

Bluebirds Nursing Home 25/01/05

Bluebirds Nursing Home 23/08/04

Bluebirds Nursing Home 05/01/04

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

CARE HOME ADULTS 18-65 Bluebirds Nursing Home Faraday Drive Shenley Lodge Milton Keynes Bucks MK5 7FY Lead Inspector Mike Murphy Unannounced Inspection 31st July 2007 09:30 Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 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 Bluebirds Nursing Home DS0000019180.V338497.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 Adults 18-65. 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. Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bluebirds Nursing Home Address Faraday Drive Shenley Lodge Milton Keynes Bucks MK5 7FY 01908 234092 01908 233901 gertie@pjcare.co.uk 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) P J Care Limited Mrs Agatha Coetzee Care Home 22 Category(ies) of Dementia (22) registration, with number of places Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Mental Health Nursing Care - 40 years plus Date of last inspection 25th September 2006 Brief Description of the Service: Bluebirds is a small nursing home opened in May 2001 by the present owner. The home provides 22 beds, for younger and older people with complex physical and mental health needs brought about by cognitive impairment. All twenty-two of the rooms are single accommodation and have en-suite facilities. The garden is designed to meet the needs of residents. The home is close to public transport links and has its own transport to facilitate service users social activities. The home is situated in a residential area of Milton Keynes which has all the facilities that a modern city can provide. Managers said that there are no set fees for the service. Fees are negotiated with NHS PCT’s and with local authority social services departments on the basis of the needs of the prospective resident. The range of fees at the time of this inspection was between £950 and £1350 per week. Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector in July 2007 and included a whole day visit to the home over the course of a Tuesday. The inspection included discussions with the manager, the assistant general manager, general manager (who is also the responsible individual), residents and staff, consideration of information supplied by the registered manager in advance of the inspection, consideration of CSCI survey form completed by relatives, a tour of the home and grounds, observation of practice, and examination of records. The process included tracking the care of four residents and consideration of how the home was addressing the equality and diversity needs of its residents. The home is an accessible, pleasant and spacious building located in a residential area of Milton Keynes. All rooms are single and have some en-suite (WC and hand basin) facilities. The gardens are enclosed and all areas of the home and gardens are accessible to residents. The home provides a comfortable and safe environment for residents. Processes for assessing the needs of prospective residents are good and aim to ensure that the home is able to meet those needs. The home’s arrangements for planning and providing care to residents are good. Staff liaise appropriately with healthcare professionals such as GP’s, occupational therapists, psychologists, physiotherapist and others. The home employs one activities coordinator and four activities assistants. Two activities assistants maintain cover seven days a week. Activities include outings to places of interest, shopping, hairdressing, jigsaws and discussions. Activities are usually on a one to one basis. Special occasions are celebrated and the home holds a summer garden party and Christmas party. The home maintains good liaison with relatives, holding a number of meetings throughout the year. Relatives are also consulted as part of the home’s quality assurance processes and are kept informed of significant developments. The home appears to be sufficiently staffed and it has good arrangements for the induction and training of new staff and in supporting staff pursuing NVQ 2 and NVQ 3. On this inspection weaknesses were noted in the home’s recruitment procedures and these were discussed with the managers who were present during the inspection visit and who subsequently took prompt and effective action. Overall however, the home is considered to be providing good levels of support to residents and is a service which is greatly valued by relatives. Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Procedures for staff recruitment must be more rigorous to ensure that residents are not placed at risk by the recruitment of people unsuited to caring for vulnerable adults. Greater consistency should be achieved in staff supervision to ensure that residents are cared for by staff who are appropriately supported. The staff training and development programme should routinely include the subject of good practice in the care of people with dementia. Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 7 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. Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are thoroughly assessed prior to admission. This process aims to ensure that the prospective resident and their family are comfortable in accepting the offer of a place and that the home is able to meet the person’s needs. EVIDENCE: Enquiries for places in the home are referred to the company’s head office in Milton Keynes. Where a suitable vacancy exists an assessment process is established. The assessment is carried out at the prospective resident’s current place of residence. The assessment of prospective residents is structured by an assessment tool or form. Up to the time of this inspection the home used an assessment form created by the Royal College of Nursing (RCN). In examining the care file of the most recent admission it is noted that the pre-admission assessment was carried out using that tool. The organisation has recently introduced a new assessment form in which a range of factors are assessed and scored on a six point dependency scale from ‘0’ (indicating no significant problem/low risk) to ‘5’ (indicating significant Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 10 problem/high risk). – a high score indicating a high level of need. Factors considered include (among others): behaviour, cognition (which includes ‘confusion’), communication, continence, memory, mobility, nutrition, orientation, personal care, ‘psychological and emotional needs’, risk (to self or others), senses, and skin. The assessment also includes a summary of the medical history, medication, and a list of professionals currently involved in the person’s care. The assessment and other information gathered at the referral stage is considered by managers and a decision made on whether the home is likely to be able to meet the person’s needs. Where it believes it can then the likely cost of care is calculated. The outcome is submitted to the agency making the referral – usually a NHS primary care trust (PCT). If the referral progresses further then an invitation to visit the home is offered to the prospective resident’s family. This provides an opportunity to view the facilities and talk to staff. If everything is satisfactory and all parties are in agreement then arrangements are made for admission. The home’s environment, its staffing, arrangements for staff supervision, staff training and development, and its liaison with other professionals and agencies, aim to ensure that it can meet the person’s needs. Residents may bring in personal belongings by agreement with the manager. Managers said that they always endeavour to take special requests and personal preferences into account. These may include matters related to the person’s religion, abilities, or interests - such as music. A review is held at one month and at six months – earlier if necessary. This includes reviewing how the person is settling in, how the home is meeting the person’s needs, and any other matters that people wish to discuss at that stage. On the basis of this inspection the home is considered to meets the needs of people in terms of age, gender, ethnicity, and disability. Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive care plan is in place for each resident. Care plans include risk assessments and evidence of good liaison with other healthcare professionals. Together, these activities aim to ensure that peoples’ needs are met and that their independence is supported as far as possible. EVIDENCE: A care plan was in place for each resident. The home uses the Standex system of care planning. Other files relevant to the care needs of residents are the personal file and the activity file. The personal file examined contained correspondence, risk assessments, occupational therapy assessment (focussing on daily living skills), a behaviour recording chart (based on the advice of a psychologist), and Enduring Power of Attorney (EPA) form. The file also included photographs of bruising reported to be noted on admission (although this was not dated) and a photograph of the person (although the quality of the image was not particularly clear). Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 12 The four Standex based care plans examined were generally well completed in the context of that system. The care plans include a ‘long term needs assessment’ and a care plan based on those needs. The care plan covers such matters as; personal hygiene, continence, nutrition, risk behaviours, activity, contact with family, aggression, absconding, and mobility and falls. Care plans also include a Waterlow (pressure sore) risk assessment, falls risk assessment, moving and handling assessment, and a dependency score. Daily notes in the Standex files tended to focus on physical care given and there were relatively few references to psychosocial aspects of care. The activity staff use a separate record which has been developed at the request of relatives and is accessible to them. Care plans are reviewed monthly in the home and as required with other healthcare professionals and families. A relative respondent to the CSCI survey in connection with this inspection described the care as good. The respondent wrote ‘Any concerns about [relationship] are always acted upon. Also my suggestions/ideas are listened to and requests for consultant/dietician/physio etc. acted on, although it can take some time for this to happen’. Residents have a good degree of freedom within the confines of the care environment. Over the course of the day residents could spend time alone in their room, chatting to staff, chatting to other residents, watching TV or sitting in the garden. The day was broadly structured by meals which residents generally took together with support from staff. Some residents were noted to be particularly active at times and the home seemed to accommodate this comfortably. There was a varying range of ability among the resident group present in the home on the day of the inspection visit. Staff were observed to encourage residents to make decisions e.g. on whether they would like to participate in an activity. None of the residents are able to manage their own finances and all require a moderate to high level of support, Files were noted to contain risk assessment covering a range of daily activities. Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides care and support to residents with a wide and complex range of needs. Residents’ dignity is respected and the daily routines of the home promote choice and independence in the context of the needs of individuals. EVIDENCE: The home employs one activities co-ordinator and four activities assistants. Residents may have visitors at any time. Visitors are kept up to date with developments. Residents’ needs supervision at all times when out of the home. They occasionally go shopping locally or in central Milton Keynes (about 3.5 miles away). Some residents go to church - again with staff support. Residents are free to pursue their own interests. Each wing has a TV and music centre. There is also a DVD. Residents have unrestricted access to the garden. Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 14 It was said that some residents occasionally like to be involved in light gardening. There is an activities co-ordinator for four days a week and four activities assistants, two of which cover 08.00 to 17.00 hours seven days a week. The activities staff seen said that their key role is to improve the quality of life for residents. Most activities involve one member of staff to one resident, in some cases, outings for example, two staff to one resident may be required. Residents are not able to participate for long in organised group activities. Activities include outings (e.g. to shops, local parks and Woburn Safari Park), conversation, walks, beauty sessions, haidressing and jigsaws. The home celebrates special events such as birthdays and Christmas. The co-ordinators assist other staff at meal times and encourage residents to personalise their rooms. They were selecting material (such as photographs) for inclusion in the frames of home life to be fixed to the wall in the near future. Most residents are said to be up and to have had breakfast by 10:00 am. A cooked breakfast is offered on most days. This hot dish may consist of (among other choices); grilled sausages and tomato, poached eggs on toast, grilled bacon and tomato, or scrambled eggs on toast – the choice varying from day to day. Coffee is served mid-morning. This is followed by some activities although some residents are said to be happy just resting, watching TV or reading. Lunch is served at 12:30 pm. On the day of the inspection visit this consisted of Grilled Bacon served with Mashed Potatoes followed by a cream and fruit dessert. The residents appeared to enjoy their lunch. Staff provided support where required. Drinks in the form of fruit squash or water were freely available. On other days lunch may include; Sweet and Sour Pork and Rice followed by Chocolate Sponge and Vanilla Sauce, Fish Fingers with Chips and Tomato followed by Lemon Mousse, or Pizza followed by Apple Cobbler and Custard. Soup and sandwiches are available as an alternative every day. Some residents participate in activities with staff, others again prefer to rest, read or watch TV. Afternoon tea is served at around 3:00 pm. Dinner, which is the main meal of the day, is served around 5:00 pm. Dinner choices on the menu supplied for this inspection included (among others); Quiche, Hungarian Goulash, Chicken Stew with Herb Dumplings or Sausage, Mash and Onions. Dinner desserts included; Prune and Almond Tart, Banana Custard, and Spotted Dick and Custard. A ‘Selection of Homemade Cakes’ are offered every evening. The residents in this home are relatively young and many were observed to be active throughout the day. The need for adequate nutrition and fluids is important to the residents well-being and it appeared as if the staff in the home were meeting that need. Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 15 In summarising the care a respondent to the CSCI survey wrote ‘The nursing at Bluebirds Nursing Home is very good. Everyone is always very friendly and welcoming. When I visit I am offered tea/coffee. The Christmas party/Summer garden party and BBQ are always well done and the residents enjoy them very much. The care plans are comprehensive and nursing notes detailed. When the plans are changed I read and sign them’. Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff provide support to residents as required. Arrangements for liaising with health and social care services in the community and for the control of medicines are satisfactory. These aim to ensure that residents’ healthcare needs are met. EVIDENCE: Staff were observed in providing support to residents, varying their approach according to individual needs and preferences. Personal care is provided in bedrooms or bathrooms. Residents wore their own clothes, choose their own hairstyles and all were treated as individuals. The home had the technical aids needed to provide care to the residents living there at the time of the inspection visit (as described under standards 24 and 30 below). The home was in regular contact with psychologists, a psychiatrist, occupational therapist and physiotherapist. Access to other healthcare Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 17 professionals and agencies is either through the resident’s GP or by direct referral. Medication is prescribed by the resident’s GP or consultant psychiatrist. The home’s ‘Homely Remedies’ policy is signed by the GP. Medicines are dispensed and delivered by a branch of Jardines pharmacy in Milton Keynes. Medicines are recorded on receipt and a stock check is carried out weekly. Only registered nurses administer medicines. Wherever possible a copy of the prescription is made and attached to the medicines administration record (‘MAR’ chart). A separate MAR sheet is maintained for ‘PRN’ (where necessary) medicines in order to avoid over supply of such medicines. Medicines are supplied in their original containers – the home does not use a monitored dosage system. At the time of this inspection visit only stocks of intramuscular Diazepam and Diazepam suppositories were stored in the Controlled Drugs (CD) cupboard. Medicines are stored in portable metal trolley. Controlled Drugs and surplus medicines are stored in a metal cabinet fixed to the wall. Medicines requiring cool storage conditions are stored in a fridge. At the time of this inspection the pharmacy dispensing medicines also accepts returns of unused medicines but this was likely to change in the autumn of 2007. It was reported that a pharmacy audit is carried out every six months, however, records of the most recent audit were dated August 2006. A check of the home’s storage arrangements and of the MAR charts of residents being case tracked showed everything to be in order. The clinical care manager has lead responsibility for medicines and carries out a monthly audit of storage and staff practice. Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an effective policy and procedure for recording and investigating complaints. It has a framework of policy, reporting arrangements and staff training with regard to the protection of vulnerable adults (POVA). Together, these aim to protect people from abuse and to ensure that complaints are properly investigated. EVIDENCE: The home has a complaints procedure which outlines the action a member of staff should take on receiving a complaint. The procedure requires acknowledgement of the complaint ‘..within 1 working day..’ and a full reply ‘..within 21 days’. Where a complainant remains dissatisfied the procedure states ‘…the complainant will be advised to contact a Director of the Company’. The procedure includes contact details for the CSCI in Oxford. According to the home’s records, the home received seven complaints since December 2006. CSCI has received one complaint about this service since the last inspection. As well as complaints the home has also received a number of complimentary letters from relatives about the quality of care provided. The organisation has a policy on the subject of the protection of vulnerable adults (POVA). This was in the process of being reviewed and updated at around the time of this inspection. Staff were aware of the Milton Keynes Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 19 multi-agency policy but a hard copy could not be located at the time of the inspection visit. However, managers could access or download it via the internet if required. Staff training on POVA consists of a full day within the first six weeks of employment and periodic half-day updates. It was also reported that Milton Keynes Council run regular update sessions on POVA which are attended by managers. The potential for aggression is a feature of such a service. Where this presents as a problem in this home a psychologist advises staff on a behavioural approach to its management. There are no specific training sessions on the subject of dealing with aggression but the manager said that it is touched on during induction, during training on moving & handling and POVA, in the course of mentorship and appraisal meetings, and in reviewing the care of individual residents with psychiatrists and psychologists. In-house staff training is appropriately limited to de-escalation of an event. The home looks after some money for residents. Procedures are governed by the organisation’s standing financial instructions. A folder is retained for each resident. Cash and receipts are stored in the folder. Details of transactions are recorded. A bank account is opened where larger balances are held. The General Manager reports that internal audits of residents’ accounts are conducted monthly and external audits six monthly. The cash balances for two residents was checked and found to correspond with records. The organisation’s Business and Finance manager acts as an appointee for one resident. Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 23 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides an accessible, clean and well-maintained environment which provides residents with a comfortable and safe place to live. EVIDENCE: The home is a detached building located in the residential area of Shenley Lodge in Milton Keynes. There is parking to the front of the building. Local buses serve the area and the nearest rail station is about three miles away in Milton Keynes. The home opened in 2001. It is a single storey spacious building and the quality of the accommodation is good. All bedrooms are single and have some en-suite facilities (WC and hand basin). The layout of the home and the enclosed garden facilitates the free movement of residents – many of whom are physically active for much of the day. The walls of the home looked a bit bare but staff said they were addressing this. They were planning to fit frames on walls around the home in which to display photographs, notices and other Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 21 material of interest. Because of the particular nature of the service they were unable to use a normal notice board without creating a risk to residents. One such frame had already been installed and others are due to be fitted in the near future. The home is divided in to two wings, each of 11 places. There are bathrooms, showers and WCs (including a ‘disabled’ WC) in each wing. Residents’ needs are assessed individually by a member of the occupational therapy team and equipment and facilities appropriate to needs is provided where required. The residents are physically active and are able to bathe with staff support and supervision. Each wing has a lounge and dining area. Bedrooms are of a good size and on the day of the inspection visit, 8 of 22 were equipped with ‘medical’ beds (beds which are adjustable to provide support to the resident, which allow the safe installation of bed rails if needed, and which facilitate the provision of care to the person. 14 rooms have single divan beds. Bedrooms have been personalised to varying extents by residents and their families. The home is suitably equipped to support residents. Equipment includes ‘medical’ beds (X 8), hoists, slide sheets, pressure mattresses, support rails, and a nurse call system. The laundry is well equipped and was well organised, tidy and clean. The kitchen is well equipped and was also well organised, tidy and clean on the day of the inspection visit. However, some jars of sauce (one of tartare sauce and one of mayonnaise) and a packet of ham had not been labelled when opened and, therefore, posed a potential risk to residents. The garden are pleasant and accessible to residents. They consist of areas of lawn, shrubs, areas for sitting, and a summerhouse. Standards of housekeeping were good and the housekeeping manager said that staff are trained to keep cleaning substances “out of sight and out of reach” of residents. There is always a risk that a resident will ingest a cleaning substance and staff were aware of this. Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are considered satisfactory but weaknesses in procedures for the recruitment of new staff found on this inspection could place residents at risk. Staff have access to a range of training and development opportunities. These aim to ensure that there are sufficient numbers of appropriately trained and supervised staff to meet people needs. EVIDENCE: Staff induction and training is provided by a training agency which developed from the organisation but which is now reported to be an independent training provider. 8 of 21 care staff were reported to have acquired NVQ qualifications – 6 at NVQ level 2 and 2 at NVQ level 3. 8 more staff were pursuing NVQ level 2 around the time of this inspection. The manager said that more staff were due to take up NVQ training in September 2007. Arrangements for circulating the General Social Care Council (GSCC) codes of practice to new staff seemed unclear. The present staffing provides for one registered nurse and six care staff in the morning, the same in the afternoon and evening, and one nurse and two care Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 23 staff at night (on occasions more if needed the manager said). In addition to nurses and care staff there are four activity staff and two laundry assistants on duty until 5:00 pm on weekdays, and two domestic assistants and two kitchen staff on duty for most of the day. The home is supported by the organisation’s head office in recruiting new staff. The process involves advertising the vacancy – usually in the local paper, enquirers are sent a recruitment pack by head office, applicants return completed applications forms to the office, short listing is carried out at the office, and candidates are interviewed by a panel which usually consists of the manager, clinical manager and a team leader. Two references and a POVA First and Enhanced CRB certificate required before the person appointed takes up post. Examination of staff files indicated that the process was not operating as smoothly as described. All applicants had completed an application form, although one form was considered to have been poorly completed. References were extremely basic and brief, two different forms of reference were used, and former employers were not asked why the person had left an earlier care position (as required under POVA since July 2004). The status of referees, in terms of their relationship to the applicant, wasn’t always clear. The CRB and POVA First position was not as clear as it should be. One file had a photocopy of a CRB from another employer. One person appeared to have started work before a POVA First was obtained. One file did not have a photograph of the person. These are significant weaknesses which must be addressed by the registered persons. The General Manager of PJ Care wrote to CSCI after the inspection visit. The letter included the outcome of an investigation by managers into the omissions noted above and on why they might have occurred. The organisation has issued an updated recruitment policy to its managers and a programme of training has been established. This will be completed by early September 2007 and is expected to deal with the weaknesses noted on this inspection. This is a constructive response from the organisation. Additional monitoring of practice would also be advisable. The organisation has accreditation with ‘Investors in People’. The home has a good induction programme for new staff and a good ongoing programme of training on ‘mandatory’ subjects. The programme could be enhanced by offering training on good practice in dementia care and related subjects. A summary of the programme was presented in the form of a spreadsheet. The programme includes Health and Safety, Infection Control, Food Hygiene, Patient Handling, First Aid, and POVA. Dates of basic training and update training were supplied. Email correspondence between the manager and the training organisation (’12 Training’) was also seen. Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 24 Supervision, known as ‘mentoring’, takes place every four to eight weeks. From the evidence of records examined its application in practice appeared inconsistent. All staff have an annual appraisal. Regular staff meetings are held. Staff acknowledged the training opportunities offered by the organisation. Managers were reported to be approachable and to maintain good working relationships with staff. Staff felt that the quality of care provided in the home was good and that residents were treated as individuals. They felt that the environment in the home was improving. Supervision was described as having a practical orientation. Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is generally a well managed home which has good arrangements in place for maintaining the quality of the service. However weaknesses in staff recruitment reflects a gap between management policy and management practice in that sphere of activity, with increased potential risk to residents. Arrangements for health and safety are thorough and aim to ensure the safety of residents, staff and visitors. EVIDENCE: Since the last inspection the registered manager had transferred to another home to take up a post as project manager for a new service. The current manager had transferred to Bluebirds from another home in May 2007. The manager is a Registered General Nurse (RGN) and Registered Mental Nurse Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 26 (RMN) and at an earlier time was the clinical manager for the home. He is currently pursuing the registered managers award (RMA). A mix of activities make up the home’s approach to quality assurance. Regulation 26 visits are regularly carried out by the Responsible Individual on behalf of the organisation. The service users guide is being revised and will be in the form of a ‘Welcome Pack’. This is being carried out across the organisation and a draft being worked up for ‘Mallard House Brunel Unit’, another of the homes in the group, was provided for this inspection. The document looks comprehensive. From the inspection point of view the document should include the information listed in standard 1, and, as far as possible, be in a format which meets the needs of the residents in Bluebirds. The new assessment form (summarised under standard 3 above) is considered to provide a more thorough assessment of residents needs and is expected to support the measurement and reporting of outcomes for residents. The organisation has devised a ‘satisfaction questionnaire’ and plans to use this in a survey with residents and relative in September 2007. The questionnaire covers; ‘pre-admission’ actions, ‘admission’, ‘staff’, ‘communication’, ‘activities and outings’, ‘catering’, ‘housekeeping’ and ‘general’. The responses are recorded on a four point rating scale. There are clearly problems in using such an approach with residents who have a moderate to severe degree of cognitive impairment (i.e. impairment of thinking processes) and supplementary or indirect means of gauging resident satisfaction may need to be developed for this home. The manager said that the home maintains links with support groups such as The Alzheimers Society, Pick’s Disease Support Group, and Huntington’s Disease Association. Meetings with residents and relatives are held every six weeks or so. These have a number of functions; social (a chance to meet others over tea and cakes), information (a guest speaker leads a discussion on a topic), consultation (notes are taken, information exchanged), and support (the meetings bring people with shared concerns together). A relative respondent wrote ‘There are more relatives meetings held now, which I think is a good thing’. However, the same respondent also wrote ‘Communication is a weakness. In the past I have found myself repeating the same request to perhaps four different members of staff before things happen. Whether this is a weak link in the system or the system itself? Possibly the latter.’. The organisation produces a newsletter on a quarterly basis. This covers all of the homes in the group. The Summer 2007 edition was in circulation at the time of this inspection and included information about events at Bluebirds. Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 27 A ‘clinical audit’ on an aspect of work is carried out monthly. These have included medication and care plans. The results are reported to the Board and action plans drawn up where necessary. Policies were being extensively reviewed and copies of updated policies were available on the organisation’s intranet. However, examination of staff records revealed weaknesses in the application of policies and procedures governing staff recruitment, thereby creating a risk to residents. The organisation has responded promptly and constructively to these findings. The Facilities manager has lead responsibility for health and safety matters across the organisation. Staff receive initial training on health and safety matters during the course of the first six weeks of their induction. This includes fire safety, moving and handling, food hygiene, infection control and first aid. The organisation uses a single training agency for staff induction. Contracts were reported to be in place for the maintenance and safety checks on gas and electrical appliances, fire safety equipment, the maintenance of hoists, maintenance of wheelchairs, and the removal of waste. It was reported that the home has been visited by an officer of Buckinghamshire and Milton Keynes Fire Authority during the course of week prior to this inspection visit but that a report had not yet been received. The building appears safe, the accommodation is on one level, entry and exit is controlled by staff, and the gardens are secure. Procedures are in place for conducting risk assessments and for providing appropriate levels of support to residents outside of the home. Staff are trained in dealing with aggression – essentially, and appropriately, in de-escalation. Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 2 X 3 X Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA34 Regulation Schedule 2 Requirement The registered manager is required to ensure that all the necessary documentation as detailed in Standard 34 and Schedule 2 of the Care Homes Regulations for Younger Adults. Timescale for action 30/09/07 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. Refer to Standard YA35 Good Practice Recommendations It is recommended that staff be offered opportunities to attend training and related events on the subject of good practice in the care of persons with dementia. Bluebirds Nursing Home DS0000019180.V338497.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Bluebirds Nursing Home DS0000019180.V338497.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. 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