Random inspection report
Care homes for older people
Name: Address: Bon Accord 79-81 New Church Road Hove East Sussex BN3 4BB zero star poor service 03/03/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Elizabeth Dudley Date: 1 0 0 6 2 0 0 9 Information about the care home
Name of care home: Address: Bon Accord 79-81 New Church Road Hove East Sussex BN3 4BB 01273721120 01273730983 bonaccord@schealthcare.co.uk leeminggarth@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Southern Cross (Hamilton) Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 41 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 41 41 The maximum number of service users to be accommodated is 41. The registered person may provide the following category/ies of service: Care home with Nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Date of last inspection 0 3 0 3 2 0 0 9 Care Homes for Older People Page 2 of 13 Brief description of the care home Bon Accord is a care home with nursing and is registered to provide nursing to 41 older people with mental health needs.It is owned by Southern Cross(Hamilton) Limited.Residents accommodation is spread over three floors and consists of thirtyfive single rooms and two shared double rooms. Twenty-one of the single rooms and three of the shared rooms have ensuite facilities consisting of a washbasin and wc.There are two assisted bathing facilities and three assisted shower facilities. All staircases and the front door have a secure keypad entrance system.A shaft lift serves all floors.Communal accommodation consists of three lounges and two dining rooms. There is access to a large rear garden. The home has a large garden at the front with limited parking facilities.The roads around the home are metered parking only but the home is served by public transport and there is a train station at Portslade, which is approximately twenty minutes walk from the home.The home maintains links with the local psychiatric hospitals and local General Practitioners and associated health care professionals visit the home. Care Homes for Older People Page 3 of 13 What we found:
On the 10th June 2009, two inspectors undertook a random inspection to check that the home had complied with the four Statutory Requirement notices relating to non compliance with previous requirements made at the Key Inspection. The due date for compliance with these notices was the 1st June 2009. The inspection took place over a period of six hours and was facilitated by the manager of another Southern Cross home and she was later joined by the operations manager of Southern Cross who is responsible for Bon Accord. The first statutory requirement notice stated that the registered person shall having regard to the size of the care home and the number of the needs of the service users, provide in adequate quantities, suitable and wholesome food which is varied and properly prepared and available at such a time as may reasonably be required by the service users; This inspection showed that corporate menus are now being used in the home, although there were some shortfalls generally the presentation and variety of food offered to residents has improved. There was evidence that generally residents choices were being given to them at meal times and a vegetarian menu is now in place. The menu shows that finger foods including fruit should be offered at coffee and tea time. The corporate menu showed a balanced diet although it does identify some items of food that are not in season ie Brussels sprouts. The cook had rightly substituted this for fresh broccoli which is readily available. Staff were seen assisting residents with their meals in an unhurried manner, and whilst residents are waiting in the dining room for their meals to be served, they are given bowls of corn crisps or cheese and biscuits to occupy them. The presentation of the food and the quantity served has improved. The second statutory requirement notice stated that The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of the service user, ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of the service users. Duty rotas, discussion with staff and observation of the residents and the establishment showed that over the past two months staffing levels have been increased. Staff said that the staff in the afternoons have been increased and there are generally sufficient staff to ensure that things get done. Housekeeping staff have had their numbers increased by one, the senior housekeeper stated that having one extra member of staff has made it possible to commenced deep cleaning throughout the home. A second kitchen assistant recently appointed to the staff has since left, the operations manager was in the process of interviewing and applying for the relevant documentation for a new kitchen assistant. Staff did express concerns about what would happen when staff took holidays and staffing levels were reduced, the operations manager gave assurances that either agency staff or staff from the sister home would be brought in.
Care Homes for Older People Page 4 of 13 An activities co ordinator has now been employed on a full time basis and residents appear to be benefiting from the increased involvement. A statutory requirement notice was issued regarding the number of bathing facilities available to service users: The registered person shall having required to the number and needs of the service users ensure that- there are provided at appropriate places in the premises sufficient numbers of lavatories, and of wash-basins, baths and showers fitted with hot and cold water supply. However currently there are no sit in baths available for residents. This is primarily due to the bath room on the 1st floor having been stripped out ready for refurbishment and failure to complete by the contractor and to the failure of the assisted bath seat in the bathroom on the top floor. The company is required to furnish the Care Quality Commission with completion dates for both these rooms and the restoration of adequate baths for the residents. This should be within a reasonable timescale given that the compliance date was the 1st of June 2009. A new wet room has taken the place of the bathroom on the ground floor, this is, apparently, popular with residents. The fourth Statutory requirement notice stated that The registered person shall make suitable arrangements to ensure that the home is conducted in a manner that respects the privacy and dignity of service users. Observation of residents showed that the level of personal care had improved. It appeared that more care had been taken with the personal care of residents and their clothing. Staff were sitting with residents in the conservatory and residents were becoming involved with activities. Daily care charts had been filled out although there were some shortcomings in these. What the care home does well: What they could do better:
Whilst improvement around the quantities and presentation of food was noted, the catering staff are not following the corporate menu insomuch that this states that a choice of fruit juice should be offered to residents at breakfast. There was no fruit juice in the home and the catering staff implied that this was due to budgetary restrictions. This was denied by both the acting manager and the operations manager. The menu also stated that at morning coffee time, residents should be offered finger foods including crisps, and a fruit platter. During this inspection only biscuits were available and staff did not appear to know who was responsible for providing the platter. The only fruit available for 40 residents was a fruit bowl containing five bananas, 2 kiwi fruits and 4 satsumas. There was no other fruit in the home. One relative said her mother liked grapefruit in the mornings and that she brought this in for her, however there was a
Care Homes for Older People Page 5 of 13 tin of grapefruit segments in the kitchen therefore negating the need for this. There was evidence that the cook was unsure about the need for residents to follow their preferred diet and their rights to do this as detailed under the Mental Capacity Act. Three residents food and fluid charts were examined, these showed that two of these three residents were having either under or just 1000mls of fluid a day and the other resident had 1006 mls on one day. These were details recorded from a period of one week to three days. Registered nurses are accountable in ensuring that charts are filled in and residents are being offered sufficient fluids. Three daily care charts were examined and these showed that there was no mention of oral care been given. Staff must be reminded of the importance of oral care in all residents whether or not they use dentures. There was no evidence of a resident having their position moved for several hours on the day of the inspection. A requirement has been made reminding registered nurses of their accountability in monitoring all aspects of a residents holistic care and that it is their responsibility to check that nursing and fluid/food charts have been completed in an accurate manner by care staff. The majority of the requirements were from the last inspection, these were not assessed at this inspection and therefore remain. These will be assessed at the next key unannounced inspection. The provider is required to inform the Care Quality Commission of the proposed timescales for the completion of the bathrooms detailed in the summary of this report. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 1 4 That the Service User Guide 01/05/2009 and Statement of Purpose is produced in a format which is in suitable easily read format to be used by the service users admitted to the home. That it is reviewed to showchanges in the management structure of the home and includes the information that the individual service user is financially responsible for providing extra equipment they may required. The Statement of Purpose and Service User guide must be able to be read and understood easily by the service users living in the home. It must be factually accurate, open and transparent and clearly define areas not covered by the fees. 2 7 15 That care plans are formed 30/04/2009 and reviewed in consultation with the service user or their representative where it is possible to do so To ensure that service users or their representatives are aware of and agree with the Care Homes for Older People Page 7 of 13 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action care that they receive. 3 9 13 That the standard of 30/03/2009 medication complies with the Nursing and Midwifery Guidelines and Pharmaceutical regulations. That prescribed creams supplements and medications are only used for the people for whom they are prescribed. To ensure that service users are not put at risk and that there is no risk of misuse of drugs. 4 12 Reg 16(m)(n) That the programme of activities provides sufficient activities on daily basis to ensure that all levels of ability are catered for. 16 That the programme of activities provides sufficient activities on daily basis to ensure that all levels of ability are catered for. This was a previous requirement with a compliance date of 18th May 2008 To enable service users to lead as fulfilled a life as their abilities allow 6 18 Reg 13(6) That the adult safeguarding policy shows the reporting protocols in the home to be in line with the `MultiAgency Guidelines. 10/05/2008 18/05/2008 5 12 30/04/2009 Care Homes for Older People Page 8 of 13 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 7 19 23 That the provider ensures 30/06/2009 that the standard of maintenance in the home is improved, that carpets and chairs are cleaned or replaced and that necessary items in the home are repaired or replaced. That lighting in the home is of a sufficient standard to provide suitable lighting for service users and staff. To improve the home for service users and to prevent accidents. 8 26 13 That the standard of cleanliness within the home is improved To make the home a pleasant place for service users and prevent the spread of infection 30/04/2009 9 29 19 That the management ensures that no staff are employed without all checks as required by the regulations being in place To ensure the safety of service users. 10/04/2009 10 38 37 That the registered person 23/04/2009 shall ensure that the CSCI is kept informed of any incidents affecting service users including adult safeguarding. To ensure that the CSCI is kept informed of any risk to Care Homes for Older People Page 9 of 13 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action service user Care Homes for Older People Page 10 of 13 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 12 16 That registered nurses maintain their accountability in monitoring all documentation relating to the holistic care of the service users including fluid and turning and other nursing charts in service users rooms To ensure the care of the service users is maintained 01/07/2009 2 21 23 That the Care Quality 01/07/2009 Commission is provided with a reasonable timescale for the completion of the work to the bathrooms identified in the report. To ensure that there are sufficient bathing facilities for service users. Care Homes for Older People Page 11 of 13 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 13 of 13 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
