Inspection on 18/04/07 for Bon Accord

This inspection was carried out on 18th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bon Accord 20/08/09

Bon Accord 10/06/09

Bon Accord 03/03/09

Bon Accord 03/04/08

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

CARE HOMES FOR OLDER PEOPLE Bon Accord 79-81 New Church Road Hove East Sussex BN3 4BB Lead Inspector Elizabeth Dudley Key Unannounced Inspection 18th April 2007 09:30 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 Bon Accord DS0000068548.V335899.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. Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bon Accord Address 79-81 New Church Road Hove East Sussex BN3 4BB 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) 01273 721120 01273 730983 leeminggarth@schealthcare.co.uk Southern Cross (Hamilton) Limited Vacant Care Home 41 Category(ies) of Dementia (41), Mental disorder, excluding registration, with number learning disability or dementia (41) of places Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users must be aged fifty (50) years or over on admission. The maximum number of service users to be accommodated is fortyone(41). Service users with mental health needs only to be accommodated. Date of last inspection Brief Description of the Service: 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. Resident’s accommodation is spread over three floors and consists of thirty-two single rooms and five 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 four assisted bathing facilities and one assisted shower facility. 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. The fees, as informed by the manager as of the 18 April 2007, are £600-£700 per week, with extra charges for service such as chiropody, hairdressing and newspapers. Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection for this home since the provider changed to Southern Cross (Hamilton) Ltd This unannounced key inspection took place on the 18th April 2007 over a period of eight hours. It was facilitated by Mrs M Elhefwany, home manager. During the course of the inspection conversations were held with 5 residents, 8 staff, and five visitors and their impressions of the home gained. All residents were seen. A tour of the home took place during which six rooms were looked at and all bathrooms; communal areas, clinic room and kitchen were seen. Documentation, which included care, plans, medication records, staff personnel files, health and safety records, catering plans and menus and training records were examined. Five questionnaires from relatives and representatives and two from General Practitioners have been received, written comments from relatives were positive but two mentioned the lack of activities and mental stimulation for residents in the home. Questionnaires received from the health care professionals were positive with one General Practitioner stating that there was a good manager and senior member of staff. Residents and relatives spoken with, generally made positive comments about the home: ‘I like living here’, ‘ The staff are nice and the food is alright’, ‘ We looked at 22 homes prior to moving her here and we are satisfied’. ‘ Things are improving, although they still don’t get the food right’. ‘ There is a need for more stimulation for the residents, more activities’. What the service does well: The home provides nursing care for older people with mental health problems. This is undertaken in an understanding and caring manner, with resident’s dignity and choices being respected. Residents have freedom to wander around the home and the garden with keypad locks protecting them from the stairs and wandering out of the front door. Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 6 Registered mental health nurses are on duty on each shift and these are supported by Registered general nurses and care assistants, over 50 of who have the National Vocational Qualification level 2 or 3 in care. Staff contact other health care professionals including wound care specialist nurses, Psychiatrists, General Practitioners and Community Psychiatric nurses for advice as required. What has improved since the last inspection? What they could do better: The manager’s roles and responsibilities are not clearly defined and therefore during the inspection she was not always able to reassure the inspector that she was able to rectify issues raised by the inspector. Residents would benefit from a structured activities programme, which is appropriate to their abilities, and the activities co-ordinator should have training relating to providing suitable activities for this resident group. Activities provide a major part of the care for residents in this registration Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 7 category, the home being expected to provide a therapeutic environment with nursing available if the residents require it, as such greater emphasis on stimulating and therapeutic activities is required. All levels of staff require some training relating to the work they expected to perform and various training required which includes ‘Safeguarding of Vulnerable Adults’, ‘Food hygiene training’ and some training relating to the older person with mental health needs. Records of resident’s financial transactions with the company should be kept at the home for inspection. It was noted that there was lack of confidentiality insomuch that care plans were left unattended in the dining room resulting in residents looking at those belonging to other people. Although some rooms have been redecorated and the new carpets have been supplied for some rooms and the ground floor corridor, it has been noted from both Regulation 26 reports (reports provided to the CSCI by the representative of the owner) and by observation during the inspection, that several rooms are still in need of redecoration and that new carpets are needed both in some residents private accommodation and in upper floor corridor. During the inspection it was seen that hospital beds were being used for residents that did not require physical nursing care and that not only does this not add to the homely environment that is expected of a care home, but also some residents could have difficulty in climbing into them. Some furniture in resident’s rooms was also in need of replacement. The CSCI will be requiring the company to send in an improvement plan, which will show their long –term plans for refurbishment of the home. Only one assisted bath and one assisted shower was in working order and this is not sufficient for the number of residents in the home and could impact on their health, dignity and well-being. An immediate requirement to notify the CSCI about reasonable timescales to address this was made. There were no storage facilities for hoists, wheelchairs etc and plans to rectify this should be included in the improvement plan Some of the doors to resident’s personal accommodation were propped open, which has implications for the safety of residents in the event of fire. An immediate requirement for the manager to liaise with the fire service regarding this was made. Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 8 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. Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 9 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 Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 10 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): 1,2,3,4,5,6 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Prospective residents receive sufficient information to ensure that they or their representatives are able to make an informed choice regarding whether they wish to live at Bon Accord. Registered mental health nurses are on duty throughout a twenty-four hour period therefore ensuring that residents receive the specialised care that they require. EVIDENCE: There is a Statement of Purpose and Service User Guide both of which have been reviewed to reflect the current status of the home and comply with the regulations and the National Minimum Standards. The Service User Guide has also been produced in a cassette tape version for those residents who are not at ease with the written word. All residents have a copy of the Service User Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 11 Guide, and copies of this and the Statement of Purpose are available in the entrance hall. All residents have had a copy of the Terms and Conditions of Residence, and the majority of these had been signed by the resident or their representative. All prospective residents are assessed by a Registered Mental Health Nurse prior to their admission to the home; this ensures that the home can meet their needs. The preadmission document contains information relating to the psychological, physical, general health and social needs of the resident and forms the basis of the care plan. The manager or her representative uses her skill and judgement to carefully manage the assessed dependency of potential admissions. This ensures the impact of that admission is managed to ensure the well being of all persons who use the service. There are Registered Mental Health Nurses covering every shift over the twenty-four hours, Registered General nurses support them over the daytime hours. Fifty one percent of the care assistants have completed the National Vocational Qualification level 2 or 3 in care, with further staff about to commence this. Prospective residents are admitted for a four weeks trial period and residents or their representatives are able to visit the home prior to making the choice of whether they wish to live there. Residents are not admitted for intermediate care but accepted for respite care. Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 12 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): 7,8,9,10,11 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Care plans are comprehensive and identify the needs of the residents, giving clear instructions on how care to them is to be given to meet these. A few care plans have not been reviewed on a regular basis and the involvement in the care plan of the resident or their representative, in the formation and review of the care plan, is not always evident. The administration and recording of medications are of a sufficient standard to ensure resident’s safety. EVIDENCE: A total of six care plans (15 of total) were examined. These addressed the psychological, physical and social needs of each resident and were detailed and concise, giving appropriate guidance for those undertaking the care. Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 13 All care plans were formed from the initial pre assessment details, and in most cases showed evidence of monthly or more frequent review, with the majority showing that the resident or their representative had been involved in the care plan. The manager should ensure that all care plans are reviewed at least monthly; in one case the review had not taken place for four months. Residents or their representatives are involved in the formation of the initial care plans and staff said that this also occurred when there is a major review; evidence is needed of this. Good risk assessments were in place in all care plans. There was evidence of involvement by the wound care specialist nurse and other health care professionals, however there was no evidence of regular physiotherapy involvement. Nutritional care plans need to show when a resident has special nutritional needs including diabetic or soft diets. The majority of residents have been weighed at regular intervals and actions taken to address any concerns Records relating to challenging behaviour and what triggers resident’s behaviour were not always up to date. Likewise, resident participation in the recreational activities was not always recorded. Bedrails are required for many of the residents in the home, and whilst risk assessments are in evidence in all care plans, consent forms for these are not in place. These are advisable and it is good practice to ensure that two members of registered staff sign these if a resident or their representative is unable to so. It was noted that the implications on pressure damage that conditions such as diabetes may have, were not included in the care planning. There are specialist mattresses and cushions in the home for the prevention of pressure damage, and discussions were held with the manager relating to the benefits of a mattress audit being undertaken by the Wound Care Specialist Nurse. Residents appeared to be clean, tidy and well cared for. One resident said ‘ The care is very good here they look after me well’, and a visitor stated ‘ The care appears good, the residents always look clean and tidy’. A concern had previously been raised that staff were not always aware of some needs of residents including swallowing difficulties that the resident may have, however these were recorded in the care plans with appropriate actions to be taken. All medical and nursing interventions take place in the resident’s own rooms and there was evidence of staff using the preferred name of the resident. The wishes of the resident were respected and staff seen complying with residents Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 14 requests to take them to their rooms or for a cup of tea etc. There is a robust system of medication, which ensures the correct receipt, storage, administration and disposal of medication. All medications had been signed for following administration and recording and storage of controlled drugs were in order. Some medications given require monitoring of the levels present in the residents blood, and the community phlebotomist provides a phlebotomy service. One of the registered nurses also has these skills, and it is recommended that this be extended to the other registered nurses. There are no residents that self medicate at present, but there are policies and procedures relevant to the medication system within the home. Few staff have attended any courses or study to enable them to update their skills in relation to the terminally ill or dying resident. As all residents can remain in the home in their final days it is recommended that staff update their skills in this matter. Bon Accord DS0000068548.V335899.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. The provision of activities is not sufficient to ensure that all residents are kept mentally stimulated and involved. Residents are encouraged to use all parts of the home and if able can maintain independence by going out unsupervised. Visitors are welcomed at any time and residents are encouraged to maintain family links. A balanced diet is provided but residents would benefit from the catering staff receiving training on the dietary preferences of this category of residents. Nursing and care staff were seen to be engaging residents in conversation whilst assisting them with meals, and assistance was given in a discreet and dignified manner. EVIDENCE: Residents in the home have freedom to wander around the home and into the rear garden as they wish, there was evidence that they are able to access their Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 16 own room at any time and members of staff were seen to be willing to take them to their rooms at any time. Residents and staff spoken with said that residents can choose what time they go to bed and get up in the morning, and that there is choice in other activities of daily living. There is no activities programme on view to inform residents although there is a programme informing staff of what is happening on a particular day. Information was given stating that an artist, musicians and other entertainers come into the home monthly, that a Reflexologist visits and that residents can take part in Bingo, Scrabble and other board games. Some outings take place with four residents being taken to a farm for lunch on this day. However there were no activities taking place for those left at the home. Recreational activities were not recorded on a regular basis in the care plan, so one-to one time spent with residents or activities which individual residents may enjoy ere not documented. The activities co-ordinator is employed on a part time basis and several staff and visitors to the home said that more time needs to be given to activities, as residents are not stimulated sufficiently. One member of staff said ‘ Some of them come down in the morning and sit in a chair, get up have meals and sit in a chair’, whilst another said ‘ We try to give them as much one-to-one time as possible and talk to them, but it is difficult when there are so many with such high physical care needs’. Visitor’s completed questionnaires that were sent out and received by the home identified that more activities were needed. Feedback received by CSCI both in written and verbal form identified that the stimulation received by residents was inadequate. Given the homes registration it is expected that a greater emphasis will be put on the therapeutic and social needs of the residents, and this will form the major part of the care, with physical nursing being provided to those who so require. The provider will be expected to submit an improvement plan to the CSCI, which will detail their proposed actions to address this issue. Residents who are able to do so, are encouraged to go out on their own, with one resident going out to the local shops, risk assessments are in place relating to this. There is an open visiting policy, with one visitor saying that she comes in every day ‘ at any time of day’: she states that she is always welcomed and she is kept informed of any changes in her friend’s condition. Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 17 Ministers of religion visit the home with services being held once a month. Residents can bring in their own possessions to personalise their rooms. At present few residents have advocates apart from those provided by the parent company, discussions were held with the manager relating to accessing independent advocates for residents. Visitors to the home said that generally the standard of catering had improved although one questionnaire identified that there was ‘too much gravy and sauces on meals’. On speaking with the cook he provided a monthly menu, which appeared well-balanced and included fresh fruit and vegetables. It was noted that a cooked breakfast can be supplied in the mornings, but he stated that the night staff provide this. Records showed that few night staff have their ‘Food Hygiene Course’ also, given the amount of night staff on duty and the number of residents requiring help with their meals this may result in some residents not being able to have the cooked breakfast if they wished. Discussions were held with the manager relating to this and the timing of breakfast, which commences at 7am. The day’s menu is taken round the previous day by care staff, therefore giving residents the choice of what they would like. Two main choices are available and the menu is written on chalkboards in both the downstairs corridor and the dining room. However few residents appeared aware of their being able to choose their meals, which could be due to their illnesses in this registration category. It was noted that of the two choices available for the past week, none had been a vegetarian option. It was also noted that finger foods were not on the menu, and the cook agreed that these were not generally provided, whereas for this category of resident a balanced diet can be provided with finger foods rather than expecting the resident to sit down for a long period of time. Catering staff would benefit from training in the nutritional and dietary preferences of this category of resident. It was pleasing to see Registered nurses involved in helping the residents with their meals and also to see that staff talk to the residents whilst helping them rather than talking amongst themselves. It was noted that tables were laid out with tablecloths and cutlery prior to the meal thus providing a homely atmosphere for residents. Liquidised and soft diets were also attractively presented. All residents are offered a cooked supper and sandwiches are taken around during the evening. Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 18 The kitchen was generally clean with evidence that all fridge and freezer temperatures are recorded and all catering staff being in possession of the ‘Food hygiene course’. Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 19 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): 16,17,18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There is evidence that the home has co-operated with other agencies and addressed any complaints made in an open and transparent manner, ensuring that residents and visitors to the home feel able to bring any issues to the attention of the manager. Staff do not receive training in ‘safeguarding of vulnerable adults’ at the present time, participation in this would enhance resident’s safety. EVIDENCE: The home has a complaints policy, which meets the regulations and is displayed in the main hallway and included in the Service User Guide. Residents and visitors spoken with were aware of how to make a complaint and generally thought that these would be dealt with in an acceptable manner. There have been three complaints in the past six months, one of which was sent to the CSCI. This complaint involved staff knowledge of care to be given and the standard of furniture in the room. Whilst the element of the complaint relating to the furniture has been addressed and the complainant is happy with Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 20 this aspect, the care element of the complaint is being addressed by social services and they have made some recommendations to the home. A further complaint was made over the number of comfortable chairs available- this was addressed by the home, and another about a residents spectacles that were missing and the resident sitting in a wet chair. These have been addressed. During the past six months there have been four ‘Safeguarding of Vulnerable Adults’ referrals. Two of these were unsubstantiated, recommendations have been made to the home regarding the third issue by Social Services, and the relevant authorities are at present investigating the fourth issue. It was noted that the manager and the company have co-operated fully in the safeguarding adults investigations and have fully investigated any other complaints that have been made. The CSCI has been fully informed by the home throughout and the home has maintained good records of all the incidents. Few staff have attended ‘Safeguarding Adults’ training and of those that have attended this require updating. There was no evidence of basic ‘Safeguarding Adults’ training in the present induction course and the manager has not include this in any informal training. This was discussed with the manager with proposals that this be addressed. Residents who are able can take part in the civic process by postal voting; the manager will help residents to access solicitors and financial advisors if required. Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 21 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): 19,20,21,22,23,24,25,26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home is clean and free from odours; there are plans for further redecoration in order to maintain a pleasant home for residents use. Some of the furniture in resident’s individual accommodation does not promote a homely environment. EVIDENCE: Bon Accord has resident’s accommodation over three levels, this comprises thirty-two single rooms and five shared double rooms, all accessible by a shaft lift. All rooms are of a size as detailed in the National Minimum Standards. Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 22 Communal accommodation consists of three lounge areas and two dining rooms, a conservatory area and a large reasonably maintained rear garden. Residents have access over the entire home including the rear garden, although keypad security devices access staircases and the front door to ensure resident’s safety. It was seen that those residents who are deemed able to move around the home safely have been given the keypad codes so that they are not restricted. This is considered good practice, however if their abilities change then appropriate measures to protect them should be put in place. New carpets have been put down in the lounges, the ground floor corridor and some rooms, and redecoration has taken place in parts of the home. There are areas of the home, i.e. bedrooms and some corridors, which would benefit from redecoration and new carpets. New chairs have been purchased for communal areas and some rooms. There are four assisted baths and one assisted shower room, however three of the baths are in need of repair and therefore only one is available for use at present. An immediate requirement was made at the inspection with the manager being required to ensure that the baths will soon be in working order. Twenty-one single rooms and three double rooms have an ensuite bathroom consisting of washbasin and WC. Other rooms are provided with washbasins. There are sluice rooms and a laundry room provided in the home. The premises was previously assessed by qualified person, it has grab rails in bathrooms and toilets, three hoists, some new beds which are able to be used for both residents that need nursing care and mobile residents, and a range of moving and handling equipment. There are some pressure relieving mattresses and cushions available in the home. Individual residents rooms are fitted with locks and a lockable drawer, residents are provided with keys under the auspices of a risk assessment. It was noted that some rooms there are hospital beds, this does not add to the homely atmosphere when in rooms where residents do not need physical nursing and some residents will have difficulty in getting into them without staff assistance, the manager stated that these are gradually being replaced. Residents are able to bring in possessions to personalise their rooms. Regulation 26 visits (responsible person monitoring visits) have identified many of the issues raised relating to the maintenance, décor and furnishings in the home, and at present the home is not meeting the National Minimum Standards in this respect. The provider will be expected to submit an improvement plan to the CSCI. Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 23 All windows have restricted opening and there was evidence of water temperatures in resident’s outlets having been monitored, however records identified that some of these were on the lower level of recommended parameters and need to be adjusted to ensure maximum levels of comfort for residents. The home was clean and free from odours. Linen was fit for purpose and was clean and ironed. Soiled linen is transferred to red bags for laundering. There were adequate supplies of disposable gloves and aprons. It was noted that the underneath of the bath seat was unclean and staff must be reminded to ensure that this is cleaned following each individual use. There was no evidence that staff have undertaken training in infection control. Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 24 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 adequate This judgement has been made using available evidence including a visit to this service. There are sufficient staff on duty to meet the assessed needs of the residents in the home, however sufficient staff are not always available at key times of day thereby residents may not get the required attention at these times. Staff training is taking place, but some areas require attention in order to ensure the safety and wellbeing of residents. The home operates a robust recruitment system, which prevents residents being put at risk. EVIDENCE: The duty rota showed that there were sufficient staff on duty over a twentyfour hour period to meet the assessed needs of the residents. However staff spoken with and some visitors stated that the during peak times of day i.e. early morning, evenings and meal times that staff found it difficult to meet these needs as efficiently as at other times of the day. The manager is considering alternative deployment of staff to ensure that resident get the required attention. Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 25 Fifty one percent of staff have the National Vocational Qualification level 2 or 3 in care with a further five members of staff commencing study for this. The home provides an induction for new staff, which is compatible with the national guidelines, and all new staff undertake this over a period of approximately six weeks. It was noted that there is nothing in the induction that addresses the specific needs of the older person with mental health needs or the safeguarding of vulnerable adults. Staff, including the Registered General Nurses, stated that they had training needs which included a ‘Dementia training’ course, ‘Challenging behaviour’ and ‘Restrictive practices’. The training matrix showed that some staff had received training in ‘ Safeguarding of Vulnerable Adults’ but this now needs updating to ensure that they are familiar with current reporting protocols. The majority of the training recorded in the training matrix was mandatory training such as moving and handling and fire training. Some staff still require moving and handling training, but the home has three members of staff who are now trainers in this and this is being taken forward by them. It was noted that members of night staff who prepare breakfast require the ‘Food Hygiene’ training. Six personnel files, containing records of new and existing staff, housekeeping, care staff and registered nurses were examined. These contained all documentation as required by the regulations and evidenced that all pre employment checks had taken place. Staff stated that they were not employed prior to their Protection of Vulnerable Adults check being received and in most cases had not commenced work until their Criminal Records Bureau check was in place. Those that commenced work prior to the Criminal Records Bureau check being in place had been supervised whilst working. Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 26 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): 31,32,33,34,35,36,37,38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Some management systems in the home need addressing to ensure the safety of residents, visitors and staff and to ensure that the quality of the services offered to residents by the home meet their expectations and those of their representatives. EVIDENCE: The manager Mrs M Elhefnawy, is a Registered General Nurse level 1 and has been in post for six months. Prior to joining Bon Accord she worked as Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 27 manager five years in two other care homes. She is in the process of completing an application to be registered with the CSCI and is aware that she needs to have the Registered Managers Award. The manager’s roles and responsibilities were not clearly defined and in with some issues she was not able to reassure the inspector that was able to rectify issues raised by the inspector. The ethos in the home was good, staff spoke positively about the management and visitors said that they could see ‘improvements’ in the home. A questionnaire received back from a visiting General Practitioner stated ‘ Good management and senior in home’. There was no evidence of a Quality Monitoring process in the home other than questionnaires sent to relatives and visitors. Comments made on these have been noted by the manager but it is unclear at this stage whether they have been collated and action taken or if they are waiting to be addressed. A relatives meeting was held in November 2006 and staff meetings have taken place bi –monthly. Staff stated that they felt able to make their views known at the staff meetings and that these were listened to and acted upon. Evidence of a system, which includes general monitoring throughout the home, should be in place. This should include viewpoints of stakeholders, staff and health and social care professionals in order to afford a sound basis for making improvements to afford residents the maximum quality of life within the home. Policies and procedures are generic to the parent company at present and must be reviewed to ensure they reflect the practice currently taking place at the home. Most records are kept in a secure manner. However on the day of the visit to the home, care plans were seen to be out in the dining room without a member of staff present with residents looking through them, this is a breach of confidentiality. The business plan for the home was seen, and appeared satisfactory apart from inconsistency regarding continence products. The head office of the company is the appointee for resident’s finances. Although there were records relating to the money when it comes into the home, there were no records of how much money is collected for each individual resident and therefore it was not possible to audit trail this back. Records of money collected for residents should be made available to the home and be open to inspection. Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 28 There was evidence that staff supervision is taking place at the intervals indicated by the National Minimum Standards. Regulation 26 (provider monitoring visits) take place on a monthly basis and have been sent to the CSCI. Most staff have undertaken recent fire training, and there is a current fire risk assessment, however some resident’s rooms were seen to have the doors propped open with furniture or towels and an immediate requirement was made for the manager to contact the fire officer for advice. The moving and handling trainers within the home are in the process of updating all staff on moving and handling practices, and some staff have attended health and safety training. There were risk assessments in place for the home and for individual residents. All accidents and incidents have been correctly recorded and regulation 37 reports have been sent to the CSCI about these. The CSCI did not receive a regulation 37 report relating to a heating breakdown and this was noted from records in the home. The majority of certificates relating to the maintenance and servicing of utilities were in place, however there was no copy of the Landlords Gas Certificate or IEE certificate and no evidence of hoists having been serviced recently. Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 1 2 3 1 2 3 2 2 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 3 2 3 1 2 Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? N0 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 OP7 Regulation Reg 15 (2) (b)(c)(d) Requirement That care plans are reviewed on a regular basis and that service users or their representatives are informed and consulted about formation and review of their care plan That a programme of activities is formed following consultation with service users or their representatives and that service users engage in activities suitable for their interests and abilities. That sufficient working bathing facilities are provided for service users. This is an immediate requirement That all grades of staff receive training appropriate to the work they are to perform as identified in the main body of the report. That there is evidence in the home of a quality monitoring system for reviewing the quality of service offered by the home to ensure it meets the expectations of service users and their representatives. That the home maintains a DS0000068548.V335899.R01.S.doc Timescale for action 18/05/07 2 OP12 Reg 16(m)(n) 18/05/07 3 OP8 OP21 Reg 23(j) 23/04/07 4 OP30 Reg 18 (1)(c)(i) Reg 24 (1)(a) 30/09/07 5 OP33 30/07/07 6 OP35 Sched 30/05/07 Page 31 Bon Accord Version 5.2 4(8) 7 8 OP37 Reg 12(4) Reg 23(4) OP38 9 OP38 Reg 13 (4) record of the homes charges to service users and the amounts paid by or in respect of each service user and that records of financial transactions between the company and the service user are available at the care home for inspection That care plans remain in a secure environment and confidentiality is maintained That the manager consults with the fire service regarding ensuring the safety in the event of fire, of those service users who prefer to have the doors to their rooms left open. This is an immediate requirement. That records of servicing of utilities and equipment are available. 01/05/07 23/04/07 30/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bon Accord DS0000068548.V335899.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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