Inspection on 17/10/06 for Bonehill Lodge

This inspection was carried out on 17th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bonehill Lodge 09/12/08

Bonehill Lodge 30/06/08

Bonehill Lodge 20/09/07

Bonehill Lodge 25/05/06

Bonehill Lodge 21/02/06

Bonehill Lodge 05/07/04

Bonehill Lodge 29/04/04

Bonehill Lodge 23/10/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Bonehill Lodge 62 Park Lane Fazeley Tamworth Staffordshire B78 3HZ Lead Inspector Mrs Mandy Brassington Key Unannounced Inspection 17 October 2006 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 Bonehill Lodge DS0000004919.V316367.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. Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bonehill Lodge Address 62 Park Lane Fazeley Tamworth Staffordshire B78 3HZ 01827 280275 F/P 01827 280275 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) Bonehill Limited Care Home 26 Category(ies) of Dementia (6), Old age, not falling within any registration, with number other category (26), Sensory Impairment over of places 65 years of age (1) Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25 May 2006 Brief Description of the Service: Bonehill Lodge is a residential home situated in the suburbs of Tamworth, Staffordshire, having access to local amenities and public transport. The home looks out onto open countryside and has a paved area to the rear and a small area of landscaped garden to the front of the home. The home provides a service for 26 older people and is also registered to care for 6 individuals who suffer with dementia. The three-storey property provides residential accommodation on both the ground and first floor, having 22 single occupancy and 2 shared bedrooms, ensuite facility is provided within a number of bedrooms. The first floor is accessible via a passenger lift. Bathrooms and toilets are located throughout the home and in close proximity to bedrooms and communal areas. The property has a large lounge, divided into two separate areas, which leads to a dining area equipped with essential furnishings to meet the needs of the service users. There is a conservatory, which leads to a small paved garden. The registered provider is Bonehill Ltd who has overall responsibility for the home. The home is currently without a manager. The deputy manager of Bonehill Lodge informed the Commission for Social Care Inspection on 17 October 2006, during the visit, that the fee level for Bonehill Lodge is between £335 and £420 per week. Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was an unannounced key inspection and therefore covered all of the core standards. The inspection took place over 7.5 hours by one inspector who used the National Minimum Standards for Older People as the basis for the inspection. A tour of the home was undertaken. The inspection included an examination of records, indirect observation, discussions with six service users, the manager, and the staff on duty. Case tracking of three care plans was undertaken. Three staff records were examined and observation of daily activities took place. The inspector ate lunch with the service users. An Immediate Requirement notice was issued on the day of the inspection for one requirement and a further twenty-eight requirements and two recommendations were made as a result of this visit. Fifteen requirements have been carried over from the last inspection. Since the Key Inspection in May 2006, the home has been subject to random inspections and follow up visits on 19 July 2006, 31 August 2006, 12 September 2006, 10 October 2006 and 11 October 2006 to monitor the standards of care and to ensure requirements were met in a timely manner. This was considered to be a poor inspection in relation to the overall care provided. The inspection demonstrated that there are a significant number of concerns and the current arrangements have meant the home is still failing to meet the National Minimum Standards and the Care Homes Regulations 2000 in relation to Choice of Home, Health and Personal Care, Daily Life and Social Activities, the Environment, Staffing and Management and administration. Due to the concerns identified, the home will continue to be subject to additional monitoring visits to ensure compliance with statutory requirements and legal advice is to be sought regarding enforcement action. What the service does well: The home was clean with no malodours and staff welcome visitors and guests in an appropriate manner. The Deputy manager supports the team of staff on a daily basis and continues to communicate well with the staff and the Commission for Social Care Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 6 Inspection. Staff working in the home, work well as a team and try and support each other under the current difficult circumstances. The service users spoke highly of the staff team and respectful attitudes were observed, and individuals enjoy a healthy banter with staff throughout the day. Service users comments relating to staff included, ‘the staff are very good and respond quickly to any call’, ‘the staff care is excellent’ the staff are lovely, very nice and kind,’ What has improved since the last inspection? The deputy manager is now working in a supernumerary capacity to ensure she has the opportunity to manage the home on a daily basis. The deputy manager has begun the complex task or planning system within the home to ensure the plans relating to identified needs and the support individuals shown by the deputy manager included information conditions, medical diagnosis and dementia. reviewing the care include information require. The plans relating to specific Training has been booked for sensory awareness and dementia and it is hoped that all staff will have the opportunity to attend. The home has reviewed the recruitment procedure to ensure appropriate preemployment checks are carried out prior to individuals starting work at the home. During the week of the inspection a Staff and Service user meeting has been planned to ensure effective communication and for individuals to participate in the daily management of the home. What they could do better: Under Inspecting for Better Lives, the home has been subject to regular inspections as the Commission has serious concerns about the management of this service. The registered person has failed to address requirements in a timely manner and the home has been without a registered Manager since July 2006. The provider needs to recruit a manager to begin the Fit person Process. The inspection has highlighted there are a significant number of concerns and demonstrated that the home needs to be managed appropriately; the registered person has not provided sufficient resources or acted upon requirements within the agreed timescale. Requirements have been made in relation to care planning; the environment, staffing and the protection of individuals and a number of requirements have not been addressed from the previous inspections. These requirements must be met within the allocated Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 7 timescale to ensure the health, safety and welfare of service users is protected. The registered provider needs to provide suitable support to staff and the management team. Staff have not been part of supervision process and do not have any formal method to address personal development, care planning or any concerns. The Statement of Purpose and Service User Guide have not met the Care Standards Act 2000 since the implementation in 2002. The documents do not give individuals an accurate account of the home and its services. No service user has received a copy of these guides. The current care planning system in place records an assessment of need but does not give information regarding how to support individual’s needs. Specific information related to any diagnosed condition is absent from the plans. The home is registered to provide care for 6 adults with dementia. The home does not provide any therapeutic support or activities for people with dementia and the staff require training to understand this complex area. Service users have not had access to activities in the home and the community and are reliant on friends and family members. Individual have commented that they are bored and are inactive during the day. Environmental requirements need to be met within the agreed timescale. Agreements made at previous inspections regarding environmental standards, the Improvement Plan and Buildings Schedule completed by the registered person have not been adhered to. The home needs to improve the current on call arrangements. The current system relies on the goodwill of staff. The Working Times Directive requires on-call hours to be contracted and a formal system is to be developed. 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. Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals do not have access to information regarding the home. EVIDENCE: The Statement of Purpose has not met the Care Standards Act 2000 since the implementation in 2002. During previous inspections feedback regarding the necessary information has been given and the home has not sufficiently acted upon this information to ensure all details relating to the home are included. The Statement of Purpose presented on the day of the inspection included environmental information relating to another home. The contracts have been amended and the Deputy Manager is in the process of issuing contracts to service users. Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 10 Staff and service users confirmed that individuals had not had access to a Statement of Purpose and Service User Guide and were not aware of the terms and conditions of occupancy. The Statement of Purpose includes details to activities provided and comments from service users following a quality review. This information is out of date and does not accurately reflect the service provided. Service users and visiting family members confirmed they had the opportunity to visit the home prior to admission and choose from available rooms. Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home needs to develop robust medication procedures to ensure all medication is safely administered. EVIDENCE: The requirement to review plans of care has been outstanding over the past four inspections. The Deputy manager showed a new care planning system to meet this requirement and reported that this is to be completed for all individuals. It is pleasing to note that the home has considered a review of plans. The deputy manager is aware of the need to ensure that evidence is available to confirm that service users and / or their representatives are offered the opportunity to participate in the care plan and subsequent reviews. The plans will be assessed within the next inspection. Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 12 The current plans record personal information, assessment assessment of risk and a moving and handling assessment. of need, Previous inspections have reported that the plans need to include specific details to meet identified needs, and information relating to dementia and specific named conditions or concerns. The inspection on 10 October 2006 identified that two people had been admitted to the home without a plan of care or risk assessments completed. An immediate requirement was issued and the home developed a plan for the individuals. During the inspection on 10 October 2006, it was noted that monthly reviews of plans had not been carried out. The Deputy Manager has now reviewed the plans and addressed this requirement. Staff have been developing a ‘Life Story’ with the service users and family members. Where this has been completed, it has included major incidents in the person’s life and a profile of the individual up to the point of moving to the home. Health needs are recorded and a history of visits by the General Practitioner, Health Care Professionals and visits to hospital are recorded along with any correspondence and details of any outcome. Discussion with service users revealed all individuals were satisfied with the level of health support provided. The home is also registered to provide a service for 6 individuals with dementia. Previous inspections have identified there was no evidence to any specific services, facilities or stimulation to meet the needs of this group of individuals. No specific therapeutic activities are currently provided. It is required that dementia care needs be met and the current care provided be reviewed to provide appropriate support and stimulation. The review of care is to include the environment and how the home is suited to the needs of individuals with dementia. The inspection on 10 October identified that the type of dementia had been recorded but staff had not been given specific information to support individuals. In addition, one individual presented complex behaviour during the first days of moving into the home. This information had been identified within the assessment but the home had not provided staff with proactive and reactive management plans. A visit on the following day confirmed the plan had been developed. Staff need to receive training for dementia and to manage complex behaviour. The deputy manager has arranged for training for dementia care and it is also required that staff receive training to manage complex behaviour to ensure the welfare of staff and service users. Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 13 The home must ensure that they are able to meet the identified needs of individuals and confirm in writing that with regard to the assessment, the home is able to meet the needs of the service user. The service users spoke highly of the staff team and respectful attitudes were observed, individuals enjoyed a healthy banter with staff throughout the day. Service users comments relating to staff included, ‘the staff are very good and respond quickly to any call’, ‘the staff care is excellent’ the staff are lovely, very nice and kind,’ Medication is stored in a locked trolley in the dining room, the inspection on 10 October 2006 identified that medication was being stored in the kitchen fridge. It is required that all medication is kept securely and a lockable medicines fridge be provided. Within the medication trolley the provision of medicines were seen to be satisfactory, the MDS system is used and a pharmacist reviews the system. Inspection of medicines revealed that two individual had recently been discharged from hospital with a small stock of medicines. Handwritten additions to the MAR charts were not being transcribed properly from the pharmacy label nor were they being countersigned to confirm the accuracy. Staff had not recorded the actual time of administration, but written AM/PM. All entries must be double checked by a second member of staff. Medication was halved manually by staff, therefore there was a risk to staff from handling the medication, inhaling medication and the remainder tablet was placed back into the blister pack after potential contamination. Medication is not to be halved; the appropriate dose is to be prescribed for administration. Tablets are not to be placed back into the packet, as there is the risk of contamination; within the medicines bag there were two loose tablets. An audit of the tablets for the two individuals was conducted and one medication had two tablets that had not been administered but all entries had been signed by staff. The home must regularly audit the medication to ensure the integrity of the MAR charts. These areas identify poor standards within the home and the need for all staff responsible for the administration of medication to receive appropriate training to safely and competently administer medication. Staff reported that they would like further information regarding the usage of medication. The home has access to Medical Pharmaceutical information. It is recommended that the home include details of the type of drug, the reasons for administration and main side effects within the home for reference. Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 14 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 poor. This judgement has been made using available evidence including a visit to this service. There are limited opportunities to engage in activities in the home or the community. There are no specific therapeutic activities for individuals with dementia. EVIDENCE: Previous inspections had identified that service users were to be consulted regarding community and activities in the home. During all random inspections service user continued to voice their dissatisfaction with the level of activities provided. Comments during the inspection and previous random inspections included; ‘I’m really bored’ ‘There’s nothing to do here’ ‘I’d love to go to the shops’ ‘I’m so bored I’ve started counting the patterns in the carpet’. Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 15 On the Inspection on 10 October 2006, it was evident from discussion with staff and service users and inspection of records that there had been one activity in the home and there had been no social or community activities. A requirement to review the current facilities and services and provide suitable activities in the home and in the community was issued. An audit of individuals preferences regarding activities has begun and a timetable of activities planned. On the day of the inspection, individuals were having their hair styled or cut by the hairdresser and manicures from staff. This will be monitored and closely inspected to ensure individuals receive appropriate activities and stimulation. Family members and friends are able to visit the home on a flexible basis. Discussion with one visitor revealed staff are always polite and welcoming and ensure visitors are included in the daily care. At lunchtime the service users ate in the dining room. A meal was taken with the service users and the mealtime was relaxed and unhurried. The meal served was beef casserole, potatoes and vegetables, and rice pudding. Four service users confirmed the food was of a good standard. Individuals are able to have a hot or cold drink with their meal. One individual has a separate diet plan and a record of the meals served is recorded. The kitchen was inspected and found to be clean and tidy with a cleaning schedule completed. Additional storage facilities on the second floor have recently been completed. The kitchen is still in need of refurbishment; the registered provider reported in the Improvement plan that this would be completed in September. This work has not been carried out. Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 16 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, 18, 19. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff need guidance and further training to ensure appropriate actions are followed in relation to the Vulnerable Adults Procedure. EVIDENCE: The home has a complaints procedure displayed in the front hall and in each bedroom. The complaints procedure has been reviewed to inform individuals that service users may contact the Commission. The complaints book was seen and there was one recorded complaint since the last Key Inspection. All the service users spoken with confirmed they would speak with the staff in the first instance and would be confident in doing so. Family members manage personal finances for all service users. The deputy manager had no concerns over individual’s finances and there was a safe facility to hold any personal monies or valuables on the property. Service users were registered to vote. Discussion with staff revealed a lack of awareness of the Vulnerable Adults Procedure. Staff need to be aware of the procedure to ensure individuals are Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 17 protected, evidence is not contaminated and staff are confident to support individuals with any disclosure. Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 18 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 poor. This judgement has been made using available evidence including a visit to this service. The home is in need of attention to bring all areas up to a good standard and to meet the identified needs of individuals. Environmental requirements are not met in a timely manner. EVIDENCE: The home was generally clean and tidy with no mal odours and communal areas were equipped with essential furnishings. A sample of bedrooms was viewed. Bedrooms have been fitted with suitable locks and plans of care record whether service users are able and want to have a key. Individuals are able to personalise and furnish their bedroom and where individuals share a room screening has been provided. The deputy manager is aware that any new Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 19 admission must demonstrate a positive choice to share if moving into a double room. During the inspection on 31 August 2006, it was noted that within Bedroom Number 10, there was evidence of damp and in the corner of the room where there had been water damage; a large number of small flies were observed emerging from small holes. The adjacent room was occupied and the wall was damp in two areas. The Emergency Pull cord above the bed was not secure and hanging from electrical cables. The sink had protruding uncovered hot water pipes. Alternative accommodation within the home was provided for one individual. A requirement was left to address these areas and to demonstrate to the Commission that they were fit for use. On the inspection on 10 October 2006, the rooms had been occupied without demonstrating these areas of concern had been addressed. Upon inspection, it was noted that the rooms had been decorated and some work had been carried out but damp areas had begun to show. It was a serious concern that the registered person had admitted individuals to rooms that were not fit for use and had not adhered to the requirement of the Inspection. In addition, bedroom 9 had the window painted whilst open and could not be closed, and a blanket had been placed in the large gap at the bottom of the window. These issued were addressed on the day of the inspection and it remains a requirement that these rooms are not to be occupied until suitable works have been carried out. The inspection on 10 October 2006 identified that the heating to bedroom 17 was not working. Temporary heating appliances were provided and assessments of risk carried out. The deputy manager reported that this work is to be completed on 18 October 2006. It is required that the home confirms that this work has been completed to a good standard. A risk assessment for the four bedrooms, rooms 8, 9, 10 and 11 has now been completed. The suitability of individuals admitted to these rooms will be monitored in line with the assessment of risk. The registered person reported in the Improvement Plan that the kitchen was to be refurbished in September 2006. This work has not been completed. The need to review the environment in relation to colours, access to areas and individual rooms for people with dementia was discussed in detail with the registered person and the deputy manager. This is to be included as part of the review as to how the home meets the needs of individuals with dementia and the support provided. An environmental plan was submitted in July 2006. This was not available in the home and staff were not aware of the plan. Inspection of the copy Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 20 submitted to the Commission revealed identified works to the kitchen; flooring and replacement of bedding had not been completed. Bathrooms and toilets were situated throughout the home and were in close proximity to bedrooms. Water temperatures were recorded, recently temperatures had been high in some rooms and work had been completed to address this. In the Improvement Plan, exposed hot pipe work is to be covered by December 2006. This is being carried out within the home and will continue to be inspected to ensure it is completed in a timely manner. The previous two inspections identified the lock on the conservatory door is a Chubb style lock and is not suitable for exit doors from the home. It was required that in conjunction with the Fire officer, a suitable lock be fitted; a separate lock has been fitted to enable easy access but the chubb style lock is still in situ. The provider reported that the Fire Officer had been contacted and a suitable lock is to be fitted following a full assessment. A ramp to the conservatory has been built to ensure safe access to the home and garden. The door to the ground floor bathroom is a sliding door. Individuals reported that this could often be difficult to open especially when using a frame. It is required that this be assessed and appropriate action taken. Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has good recruitment procedures to ensure the safety of individuals but the home needs to ensure that staff have appropriate training to be able to competently carry out their job. EVIDENCE: Staffing is provided on a 24 hour basis and on the day of the inspection, three carers worked from 8.00am until 3.00pm or 5.00pm and three carers worked from 3.00pm or 5.00pm until 10.00pm. There were two waking night staff. The shift times in the afternoon allowed for a flexible service and a thorough handover. The deputy manager is currently working flexibly across the shifts. There was a cook working from 8.00am until 2.00pm and two domestic staff providing working from 8.00am until 1.00pm. The previous Random inspection on 10 October 2006 identified staffing is to be reviewed in relation to the care to demonstrate how staffing is to provided to enable community activities, and additional support and assistance for activities for service users who have dementia. This review remains a requirement. Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 22 The home demonstrated they have reviewed the recruitment practices in the home and there are good recruitment procedures; a record of references, and CRB clearance is maintained along with copies of identity, a photograph, and medical statement. The new documentation records responses at interview and suitability to the role. The application now includes reference to the Rehabilitation of Offenders Act 1974. The home has an informal on-call system operated by senior members of staff. Discussion with staff revealed that staff are expected to use their own personal equipment to be contacted and are informally on call. The Working Times Directive states that on-call hours are to be included in the contracted hours of the employee. It is therefore required that the current on-call arrangements be reviewed to ensure an effective system be developed and staff have specific on-call hours, for which they are contracted for and therefore receive a payment. All of the staff on duty were spoken to during this inspection and observations were also made of staff attitudes and respect towards the service users. The staff members spoken to talked about service users in a sensitive and respectful way and understood the need to promote their dignity and maintain confidentiality. Service users comments regarding the staff included: ‘the staff are lovely, very nice and kind’, ‘the care from staff is excellent’, ‘The staff will do anything for you, and come straight away if you need them’ ‘The staff listen to what you say’. During the inspection, staff were observed rushing around the home and supporting individuals. On the previous inspection on 10 October 2006 on three occasions, the two inspectors present were needed to support individuals to ensure their health and welfare; two people were calling for help but there were no staff available. From observation, it was evident that staff have the skills to deliver personal care but have been unsupported. The previous inspection made a requirement to review the staffing in the home to demonstrate how you are able to meet the specific needs of the individuals within the current staffing. This requirement remains. Staff have received training for Health and Safety, Moving and Handling and Food Awareness. The random inspections have identified that staff need to receive training for Dementia Care, Record Keeping, and Sensory awareness. The Deputy Manager has organised these training sessions and this will be inspected on the next visit. Due to the changing and complex needs of the service users, staff are required to receive training in managing behaviour. Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 23 The Deputy Manager is now involved in the recruitment and selection process. It is required that suitable training for equality of opportunities and Interview selection is provided. Staff have received a copy of the General Social Care Code of Conduct. Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 24 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, 33, 36, 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The registered person has not demonstrated the home is currently managed to ensure the health and welfare of service users. EVIDENCE: The home has been without a registered manager since July 2006. Interim management arrangements have been put into place, whereby the Deputy manager is responsible for day-to-day management of the home. Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 25 The registered person must recruit a suitable manager that is competent and qualified to manage the home and meet its stated purpose, aims and objectives. The standards within the home have caused considerable concern to the Commission and the home has been inspected on a regular basis; there have been five visits to the home since the last key inspection in May 2006. The registered person has not met requirements in a timely manner and the registered person has not ensured the home is managed in a manner to meet individual’s needs and to provide a quality service. As a result of the inspection findings, legal advice is being sought regarding enforcement action. Monthly unannounced visits have been conducted by the registered person. The registered person must demonstrate that these visits include interviews with service users and their representatives, and persons working at the home, inspection of the premises, its record of events and complaints. The evidence is to be written in a report and to be available in the home. Staff do not receive formal supervision, the registered person as part of the Improvement Plan reported that this would be addressed within the new management. The management plans have changed and this must be addressed. The manager is also to be part of the formal supervision process. The first residents meeting is taking place on 19 October 2006. It is recommended the meetings are conducted at regular intervals and be recorded. The health and safety of service users and staff were promoted with safe regular fire checks and drills, lift and hoist inspections and monitoring the water system. The emergency lights need to be tested more thoroughly in line with manufacturers guidelines. The home could not provide evidence of Portable appliance testing and Gas Safety test. This evidence is required to be sent to the Commission. The home does not have a comprehensive Fire risk assessment, including an Emergency Contingency Plan. This requirement is outstanding since May 2006. The home is to develop a plan for ultimate evacuation to a place of safety and consider the needs of the service users and staffing levels. Due consideration is to be given to access alternative accommodation and emergency contact numbers. This plan is to be reviewed regularly and updated to reflect any changes. Three of the homes Policies have been reviewed during 2006 to ensure they meet changes in legislation and up to date practices. All other policies and procedures have not been reviewed. It is recommended that these be reviewed on an annual basis and dated and signed. Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 X 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 3 2 3 3 1 2 3 STAFFING Standard No Score 27 1 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X 1 X 1 Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation 4 (1)(2) 5 (1)(2) Requirement To further develop the Statement of Purpose to reflect the service provided and include all details within Schedule 1. This requirement is outstanding from reports 27/07/05,21/02/06, 25/05/06, 31/08/06, 12/09/06. The registered person must confirm in writing that the home can met the assessed needs of the service user To further develop plans of care to ensure all service users have a detailed plan and information relating to how the needs are to be met. This requirement is outstanding from reports 19/07/06, 31/08/06, 12/09/06. To review how the homes meets the needs of people with dementia and to provide appropriate activities and therapeutic support. A copy of the report is to be sent to the Commission To provide support and training DS0000004919.V316367.R01.S.doc Timescale for action 30/10/06 2 OP4 14 (1)(d) 17/11/06 3 OP7 15 (1) 30/10/06 4 OP8 24 (1)(2) 30/10/06 5 OP9 13 (2) 30/10/06 Page 28 Bonehill Lodge Version 5.2 6 7 OP9 OP9 13 (2) 13(2) 8 9 OP9 OP12 13(2) 16 (2)(m) 10 OP12 16 (2)(n) 11 OP19 23(b) 12 OP19 23 (4)(c)(iii) 13 OP19 13(4) (a)(c) for staff to safely administer medication. This is outstanding from report 10/10/06. To provide a medication fridge. This is outstanding from report 10/10/06 All handwritten entries written on to the MAR charts must also be double checked for accuracy by a second member of staff. The home must regularly audit the medication to ensure the integrity of the MAR charts. Service users should be consulted regarding their social interests and make arrangements to enable them to engage in local, social and community activities. This requirement is outstanding from reports 01/02/04, 27/07/05, 21/02/06, 25/05/06, 19/07/06, 31/08/06, 12/09/06, 10/10/06 Service users are to be consulted regarding activities in the home, and provide recreational activities accordingly This requirement is outstanding from report 31/08/06, 12/09/06, 10/10/06 To ensure that the kitchen is refurbished to a suitable standard. This requirement is outstanding from report 21/02/06, 25/05/06, 12/09/06, 10/10/06 A suitable lock is to be fitted to the conservatory door in consultation with the fire officer This requirement is outstanding from report 31/08/06, 12/09/06, 10/10/06 Hot pipe work in the home including en-suites is to be DS0000004919.V316367.R01.S.doc 30/10/06 17/10/06 17/10/06 20/10/06 20/10/06 30/10/06 19/10/06 30/10/06 Page 29 Bonehill Lodge Version 5.2 14 15 OP21 23 (2)(b) 23 (1)(a) (2)(b)(c) 13 (4)(a)(c) OP24 covered. This requirement is outstanding from report 25/05/06, 19/07/06, 31/08/06, 12/09/06, 10/10/06 To review the sliding door to the 11/11/06 ground floor bathroom in relation to service users needs To discontinue the use of 17/10/06 bedroom 9 and 10 with immediate effect until the register provider has demonstrated; Damp areas to be addressed Hot pipe work is covered This requirement is from reports 31/08/06, 12/09/06 The radiators in bedroom 17 to repaired provide suitable heating. This requirement is outstanding from report 10/10/06 To review the staffing provided in relation to dependency needs and submit the review to the Commission To review the informal on call system and to ensure the system adheres to the working Times Directives. Staff to receive training for supporting an individual with a visual impairment. This requirement is outstanding from report 12/09/06, 10/10/06 To provide support and training for record keeping to staff. This requirement is outstanding from report 10/10/06 Staff to receive training for Vulnerable Adults procedure Staff to receive training for managing complex behaviour The Deputy Manager to receive DS0000004919.V316367.R01.S.doc 16 OP25 23 (2)(b)(p) 18/10/06 17 OP27 24 (1)(2) 20/10/06 18 OP27 24(1)(2) 17/11/06 19 OP30 18 (1)(c)(i) 30/10/06 20 OP30 18 (1)(c)(i) 18 (1)(c)(i) 18 (1)(c)(i) 18 30/10/06 21 22 23 OP30 OP30 OP30 30/11/06 30/11/06 30/12/06 Page 30 Bonehill Lodge Version 5.2 (1)(c)(i) 24 25 OP31 OP36 8 (1)(2) 18(2) 26 OP38 26 (4) 27 28 29 OP38 OP38 OP38 23 (2)(b)(c) 23 (4) 23(4) training for Equality of Opportunities and Interview Selection To recruit a suitable manager to the home The registered person should ensure that all staff receive formal supervision at least six times per annum covering: a) all aspects of practice b) philosophy of care in the home; career development. This requirement is outstanding from reports 31/07/03, 27/07/05,21/02/06, 25/05/06, 19/07/06, 31/08/06, 12/09/06, 10/10/06 Monthly regulation 26 visits are to demonstrate the registered person has carried out interviews with service users, representatives, staff, daily events, records and complaints To provide evidence of Annual Gas Safety testing and Portable appliance tests To carry out additional tests of the emergency lights in line with manufacturers instructions To carry out a fire risk assessment and to include an emergency contingency plan. This requirement is outstanding from report 25/05/06, 19/07/06, 31/08/06, 12/09/06, 10/10/06 30/10/06 20/10/06 17/11/06 17/11/06 17/11/06 20/10/06 Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP36 Good Practice Recommendations To make available easy to read information regarding the usage and side affects of medication Policies and Procedures are reviewed annually, dated and signed Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Bonehill Lodge DS0000004919.V316367.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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