CARE HOMES FOR OLDER PEOPLE
Bodmeyrick Residential Home North Road Holsworthy Devon EX22 6HB Lead Inspector
Sue Dewis Unannounced Inspection 6th October 2005 10:00 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 Bodmeyrick Residential Home DS0000022136.V256911.R01.S.doc Version 5.0 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. Bodmeyrick Residential Home DS0000022136.V256911.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Bodmeyrick Residential Home Address North Road Holsworthy Devon EX22 6HB 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) 01409 253970 01409 254448 Mr Andrew Gordon Orchard Mrs Janet Lucretia Orchard Betty May Boundy Care Home 28 Category(ies) of Dementia - over 65 years of age (28), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (28), Old age, not falling within any other category (28), Physical disability over 65 years of age (28) Bodmeyrick Residential Home DS0000022136.V256911.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That the Registered Manager completes NVQ4 in Care by 2005 Date of last inspection 26 April 2005 Brief Description of the Service: Bodmeyrick provides personal care for 28 older people, some of whom may have dementia, mental health problems or a physical disability. The home is a detached property situated within easy reach of the facilities of Holsworthy. Originally an older type property it has been converted and extended to provide accommodation in 28 single occupancy bedrooms. A passenger lift enables residents to reach all areas of the home. There are two lounges and two quiet rooms. A day care service is provided on two mornings a week. The rear of the property comprises a car parking area. To the front is a lawn area that is pleasant and easily accessed. The home has a specially converted vehicle for taking small groups or individual service users out. Larger group outings use Deer Parks minibus (owned by the same Registered Persons). Bodmeyrick Residential Home DS0000022136.V256911.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five and a half hours in early October 2005. The lead inspector was joined by the pharmacy inspector for approximately 2 hours. A variety of documents were inspected, including resident care plans, finances and staff records. Two residents were spoken with in private and another nine in groups of twos and three. Three staff were also spoken with. All of the requirements and most of the recommendations from the previous report had been met. However, the registered manager was on holiday on the day of inspection and therefore staff supervision records were not inspected. What the service does well: What has improved since the last inspection? A copy of the quality assurance survey has been received by CSCI, and the home now confirms in writing that it can meet the needs of prospective residents. Risk assessments have been expanded and are now comprehensive and the carpet on the top floor corridor has been attended to. Receipts for purchases made on behalf of residents are now numbered. Bodmeyrick Residential Home DS0000022136.V256911.R01.S.doc Version 5.0 Page 6 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. Bodmeyrick Residential Home DS0000022136.V256911.R01.S.doc Version 5.0 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 Bodmeyrick Residential Home DS0000022136.V256911.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Prospective residents are assured that their care needs can be met. EVIDENCE: Four residents’ files were inspected. The file of the most recent admission contained a completed assessment form and a letter confirming that their current care needs could be met by the home. The resident confirmed that their needs were being met. Bodmeyrick Residential Home DS0000022136.V256911.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 There is a clear and consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet the needs of the residents. The health care needs of residents are well met with evidence of good multidisciplinary working taking place on a regular basis. All medicines are stored securely but some aspects of the administration system have the potential to place service users at risk EVIDENCE: Four files were inspected and all contained detailed information on each resident. Each file contained an admission assessment form, an assessment for social living and comprehensive risk assessments. There were also care plans for each resident that highlighted personal care and social needs and gave instructions to staff on how these needs should be met. For example ‘To have daily papers read to her’. The service user confirmed
Bodmeyrick Residential Home DS0000022136.V256911.R01.S.doc Version 5.0 Page 10 that this did happen. Another plan indicated that the resident liked to go to church, and again this resident said that they were taken to church regularly. All care plans had been reviewed monthly. Health care needs were identified and it was possible to see where a resident had been unwell and the doctor had visited and prescribed medication. The resident confirmed that this was the case and they were taking their medication. Hand written entries on the Medication Administration Record charts were not all signed and dated by the person making the entry or checked and signed by a second person. Medications received other than with the main monthly delivery have not been recorded. When a variable dose has been prescribed there is no record of the quantity of medication actually administered to the service user. On products with a reduced life after opening there was no record made of either the date for disposal or the date of opening. The temperature records for the medication fridge were incomplete and demonstrated poor temperature control. There was no record of supply of medicines to service users looking after their own medication or when service users went on social leave from the home. Bodmeyrick Residential Home DS0000022136.V256911.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All of these standards were inspected at the last visit. For more information please see the previous report of 26 April 2005. EVIDENCE: Bodmeyrick Residential Home DS0000022136.V256911.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All of these standards were inspected at the last visit. For more information please see the previous report of 26 April 2005. EVIDENCE: Bodmeyrick Residential Home DS0000022136.V256911.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23 and 26 The standard of the environment within the home is good, providing residents with a clean, safe, comfortable and homely place to live. There is the potential for residents’ privacy to be compromised. EVIDENCE: The inspector walked around the building and saw that it was clean and hygienic and there were no unpleasant smells. Since the last inspection the carpet on the top floor corridor has been attended to and is no longer trip hazard. Suitable locks have still not been fitted to the bedroom doors, and all residents who do have locks fitted have the same key. Bodmeyrick Residential Home DS0000022136.V256911.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The deployment and numbers of staff available throughout the day are sufficient to meet the needs of the residents. Communication within the home could be improved with a simplified handover system. The procedures for the recruitment of staff are robust and offer protection to residents. Residents would benefit from having their needs met by staff with more knowledge in specialised areas. EVIDENCE: On the morning of inspection there were 27 residents and 3 day care clients at the home. There were 5 care staff, 2 domestics and 1 cook on duty. There is also a maintenance man and driver available when required. Staffing levels appear satisfactory and staff and residents felt that there were enough staff to satisfactorily meet the needs of the residents, and have time to sit and chat. Three staff files were seen and all contained the required information. CRB (Criminal Records Bureau) checks were correctly maintained. Discussions with staff showed that they had a good knowledge of care practices and the needs of individual residents. They also said that there was a lot of training going on at the moment, but would also like some training in more specialist areas, such as diabetes and Parkinson’s disease. Both staff also felt that communication within the home could be improved and discussions were held with the staff and the Responsible Individual on this.
Bodmeyrick Residential Home DS0000022136.V256911.R01.S.doc Version 5.0 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35, 36 and 38 The home is well managed and this generally results in practices that promote and safeguard the health, safety and welfare of the residents. EVIDENCE: Risk assessments have been expanded and are now very detailed. Window restrictors are fitted as appropriate and radiators are suitably guarded. Staff supervision files were not available for inspection as the manager was on leave. Therefore the recommendation that outcomes of supervision are recorded could not be checked. Four residents’ financial records were checked, all receipts were numbered and two signatures had been obtained. However, the cash held in one envelope did not match the records. The money was later found in another resident’s envelope.
Bodmeyrick Residential Home DS0000022136.V256911.R01.S.doc Version 5.0 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X 2 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 2 2 X 3 Bodmeyrick Residential Home DS0000022136.V256911.R01.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13(2) Requirement You are required to ensure that when a variable dose is prescribed the actual dose given is recorded at the time of administration You are required to ensure that medication requiring refrigeration is stored appropriately and that the maximum and minimum temperatures are monitored and recorded You are required to ensure that the receipt of all medicines into the care home and the supply of all medications to service users is be recorded. Timescale for action 06/12/05 2 OP9 13(2) 06/12/05 3 OP9 13(2) 06/11/05 Bodmeyrick Residential Home DS0000022136.V256911.R01.S.doc Version 5.0 Page 18 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 OP9 Good Practice Recommendations You are recommended that in order to protect the service users and the home that for all hand-written entries the person making the entry should sign and date the entry and then a second person checks and signs the entry. You are recommended that for all products with a reduced shelf life after opening that either the date of opening or the date of discard be recorded at the time of opening. You are recommended to fit suitable locks to residents’ bedroom doors You are recommended to provide training in specialist areas such as diabetes and Parkinson’s disease You are recommended to improve communication procedures within the home You are recommended to ensure residents’ monies are correctly maintained You are recommended to record the outcomes of matters raised at supervision 2 3 4 5 6 7 OP9 OP23 OP30 OP30 OP35 OP36 Bodmeyrick Residential Home DS0000022136.V256911.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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