Inspection on 30/06/08 for Bonehill Lodge

This inspection was carried out on 30th June 2008.

CSCI found this care home to be providing an Poor service.

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 20/09/07

Bonehill Lodge 17/10/06

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Bonehill Lodge 62 Park Lane Fazeley Tamworth Staffordshire B78 3HZ Lead Inspector Mandy Brassington Key Unannounced Inspection 30th June 2008 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.V367227.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.V367227.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 Manager post vacant Care Home 26 Category(ies) of Dementia (6), Old age, not falling within any registration, with number other category (26) of places Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 26 Dementia (DE) 6 The maximum number of service users who can be accommodated is: 26 20th September 2007 2. Date of last inspection 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 has a paved area to the rear and a small area of landscaped garden to the front of the home. The home looks out onto rural surroundings, there is limited access to public transport and local shops due to the semi-rural location. The home provides a service for 26 older people and is also registered to care for 6 individuals who have 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 Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 5 home. The Service User Guide did not reflect information relating to the fees in the home as required. The reader may wish to approach the care provider for up to date details of the fees payable. Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use the service experience poor quality outcomes. This visit was an unannounced key inspection and therefore covered the core standards. The inspection took place over 8.5 hours by two inspectors who used the National Minimum Standards for Older Persons as the basis for the inspection. CSCI are trying to improve the way we engage with people who use services so we gain a real understanding of their views and experiences of social care services. We are using a method of working where ‘experts by experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘experts by experience’ used in this report describes people whose knowledge about social care services comes directly from using them. Prior to the inspection, the manager completed an Annual Quality Assurance Audit (AQAA) for us. There were questionnaires sent to people who use the service, professionals and staff members. One completed survey was received from a person who used the service. On the day of the inspection, there were twenty people living in the home. We, the commission examined records, carried out indirect observation of seven people who used the service, and four staff on duty. Six care plans and three staff records were examined and observation of daily events took place. A tour of the home was undertaken. The storage system and medication procedures were inspected by a pharmacy inspector. Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? There have been no significant improvements in the quality of the service provided since the last visit. Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bonehill Lodge DS0000004919.V367227.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 Bonehill Lodge DS0000004919.V367227.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, 5, 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are able to receive an assessment to make sure they will be supported in the home. Changes in support needs are not always re-assessed to ensure the home remains the best place for people to live. EVIDENCE: The home has a Statement of Purpose and Service User Guide, which records information about the home. The Guide needs to reflect up to date information about the home including actual services provided and the current management arrangements. Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 11 We examined two files for people who had been recently admitted to the home. This demonstrated that senior staff had completed a daily living assessment, which included information about personal care and well-being, communication, mobility, medication, food and meals times and sleeping. One assessment had been completed in the home during a visit and family members and all staff had been able to contribute. Examination of three files revealed that only two people had a contract. Staff reported that there was continuing discussion regarding funding with the individual and the placing authority. It is required that all people have a contract and aware of the fees payable. On the day of the visit the home was accommodating twenty people and two people were receiving hospital care. One person had been re-admitted to the home following treatment, but staff identified that the person still needed nursing care. This was discussed with staff, and it is recommended that people be reassessed prior to admission back to the home, to ensure the service can continue to meet people’s needs. The home does not provide intermediate care. Bonehill Lodge DS0000004919.V367227.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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People have plans of care which records information about how to give support to keep people well. Inadequate medication systems, storage and administration practices mean that people cannot be confident that they will receive the proper medication in a safe manner. EVIDENCE: We examined five plans of care, which demonstrated that each person had information recorded about their health needs, how people communicated, mobility and pressure area care. The plan also included details about whether a person wanted a key to their room, how individuals wanted to manage any personal post and if people wanted to vote. The key worker reviewed Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 13 information on a monthly basis, and where people were involved in the review, the plan was signed. The plan was supported by assessments of risk for moving and handling, likelihood of falls and for pain management. The home provides care for people with dementia. One plan examined included general information about good practice care for people with dementia. There was no further information relating to how this could be used to support the person. Two plans contained a Life history that included information about family members, where people had lived, their former occupation and hobbies. Staff reported that this information was extremely useful when providing individual support to each person and helped to understand and talk to people. On an annual basis, the home organises a dentist and opticians to visit and a chiropodist visits every six weeks. All people are registered with a local General Practitioner, and staff reported that the doctor visits the home to see people when required. The plan of care records when people have sought medical attention and details of any treatment or advice. Two files were examined in relation to specific falls and incidents. Information was recorded within the accident book and personal files. From records and discussion with staff, one person had injured their leg whilst transferring from a wheelchair belonging to the home. Staff reported that the footrests could not be turned resulting in skin tears. It is required that all equipment used should be suitable and safe for each person, and therefore assessed by a competent person prior to use. Staff reported that this has been resolved and the person now uses their own chair. The pharmacist inspector also visited the home as part of the key inspection to establish what progress Bonehill Lodge had made in meeting the requirements made during a visit on the 23rd May 2008. In summary, very little progress had been made in improving the handling of medicines and ensuring the health and wellbeing of the people who use this service. The medication records were still poor and could not be used to evidence that medicines were being administered as prescribed. The quantities of medication were still not being recorded upon receipt and any medication carried over from the previous month to the new month was not always being taken into account. The audit process indicated that some staff were still signing the Medication Administration Records (MAR) but not administering the medication. The handwritten entries on the MAR charts were being poorly written out and were not being checked for accuracy by another suitably trained member of staff. Where variable doses had been prescribed the records did not show what quantity had been given. When examining the MAR charts in conjunction with the Monitored Dosage System that the home had failed to Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 14 identify an error made by the pharmacy and had been administering on a number of occasions twice the prescribed dose for that medicine. We found that appropriate risk assessments and care plans were not in place to ensure that medication was administered safely and correctly, for example, there was still little or no information available to ensure that medication prescribed “when required” was given correctly and safely. Examination of a plan of care identified that staff had been administering a person’s medication in their food without their knowledge. There needs to be informed written consent before putting medication in a person’s food or drink. This consent needs recording in the care plan, noting that, if necessary, the person’s doctor, relatives and others involved with their care have been included in discussions as agreeing that this is in their best interests. There needs to be confirmation from a pharmacist that the viability of the tablets are not affected by placing them in food or drink. There also needs to be a written protocol on how the administration procedure will be executed. We also found that none of the residents had given their informed consent to allow the home to handle and administer their medication of their behalf. The pharmacist inspector observed the lunchtime medication round and witnessed some poor practices being undertaken by the staff, which placed the people who used the service at great risk. At the last inspection the pharmacist inspector was told that a refresher course on the safe handling of medication had been organised and was due to take place in mid June; this training did not take place and assessments to establish whether the staff were competent to handle and administer medication safely had not been carried out. Staff had little knowledge about the medication that they were administering. In one particular case the staff had not identified that a person frequently visiting the toilet during the night was the result of them administering a diuretic (a drug which increases the flow of urine) prior to this person going to bed. In light of some of the issues identified during the inspection, in particular the poor practices seen during the lunchtime medication round, the retraining of staff and the assessment of their competency to administer medication safely must be carried out as a matter of urgency. The organisation of the medication storage area had improved and as a consequence there appeared to be less excess stock and the oldest medicines were being used first. Bonehill Lodge DS0000004919.V367227.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 good. This judgement has been made using available evidence including a visit to this service. People are able to choose how they spend their time and whom they share their time with. Activities sometimes happen in the home and people can join in if this is of interest. EVIDENCE: The AQAA recorded that people are encouraged to take part in meaningful activities according to their own choice and capabilities, and staff respect the rights of people not to participate. On the day of the visit, people had the opportunity to have a manicure during the afternoon. The Expert by experience reported that people stated they were content to sit ad chat with their friends. People reported they used to be interested in being involved in activities but not any more. One person is involved in growing tomatoes at the rear of the home. People told the Expert by Experience that Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 16 ‘Therapets’ visit the home on occasions and sometimes they have a sing along. One person informed us that family members take her out for a drive or to visit friends. The television was on all day, and the Wimbledon tournament was being watched by some people in the afternoon. We spoke to people about the television who reported, ‘we don’t really watch it in the day, but it’s on anyway. In the evening we all decide which programme we want. We can watch our own television in our room.’ In the hallway there is a chalkboard recording planned activities for the week. Staff confirmed that activities do not always take place due to staffing commitments. Inspection of recorded activities during the last month demonstrated that people had an opportunity for a sing a long; a quiz and a local Baptist church visit each month to conduct a service. Since the last visit, more people receive a service from the home although the staffing levels have remained the same. Staff reported that this has had an impact on how many activities can be provided in the home. The Expert by Experience shared a meal with people who use the service and reported the tables were set with salt and pepper for people to use. Each person was asked what they wished to have and served individually by a carer. All persons spoken with stated they enjoyed the meals, comments regarding the quality of the food included, ‘The food’s nice here, it always pleases us’, ‘We’re always asked what we want to eat’, ‘The food is excellent and lots of it.’ One plan of care reported that the person required a liquidised diet. Discussion with staff revealed that all food is liquidised together. It is recommended that where possible, to ensure people are able to experience different flavours and textures of food, different foods should be liquidised or mashed separately. Discussion with people confirmed they are able to have visitors on a flexible basis. Many people spoke about going out with family and friends, and enjoying having visitors. The Expert by Experience commented that ‘all the ladies and gentlemen were well dressed and looked cared for, their clothes were clean and suitable. It was obvious that the hairdresser does a good job as all the ladies and gentlemen’s hair looked very nice. Some of the ladies had makeup on and or nails painted.’ Many of the people had chosen to wear slippers around the home, discussion with people revealed they were more comfortable to wear than shoes. Where people wear slippers it is recommended that an assessment of risk is carried out as poor fitting or loose slippers may contribute to people having a fall or tripping. Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 17 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. People are given information about how to complain and know who to speak to. Where staff have identified any concerns about people’s welfare, appropriate action has not always been taken to safeguard people. EVIDENCE: The home has a Complaints Procedure, which is displayed in the home and within the Service User Guide. Staff reported that the use of an advocate is promoted within the home and details are available. Discussion with one person revealed that they were aware of the complaints procedure and would feel comfortable about raising any concern. We have received one complaint since the last visit, which was investigated as part of this visit regarding care practices in the home. Inspection of records revealed that the home have recorded where people have had falls and injured themselves and appropriate action has been taken. It is recommended that equipment be assessed for use, to ensure that it is safe and suitable for people to use. Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 18 One incident was not investigated under recognised safeguarding procedures. A record of the initial disclosure was recorded but no further action taken. It is required that where a disclosure is made, it is reported under safeguarding procedures and appropriate action is taken to safeguard people. All staff need to have up to date training in managing alerts. The home records any valuables that the person brings into the home. Two personal finances were inspected and found to be accurate and records completed of all transactions. Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 19 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, 22, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is a pleasant place to stay and some areas have been redecorated and furnished to improve the standards for people. People are able to bring in their own possessions and decorate their personal room. EVIDENCE: The three-storey property provides residential accommodation on both the ground and first floor, having twenty-two single and two 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 Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 20 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 people. There is a conservatory, which leads to a small paved garden, where one person is growing tomatoes. The Expert by Experience reported that, “the lounge area is two rooms made into one; there are televisions in both areas, also a record player and radio. There is a fish tank in one area. There are several ornaments around making it very homely. It was observed that each person has their ‘own chair’. One person had fully furnished their bedroom. There are several en-suite bedrooms, others have a hand basin only but toilets are near at hand. There are two double rooms, with a curtain between each bed.” Since the last visit, the redecoration of the home has continued. Corridors are painted different colours to help people to orientate and new furniture has been purchased in the dining room. The kitchen had been identified for refurbishment although this remains incomplete. The cooker does not close securely, which could reduce the temperature of cooking and also cause harm to staff and therefore needs to repaired or replaced. There has been a recent incident where a member of staff has been injured due to poor standard of cooking equipment used. It is recommended that this be replaced and only safe and suitable equipment be used. Bonehill Lodge DS0000004919.V367227.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. Staffing in the home is not always based around the needs of people using the service, so this may affect the standards of care on some days. Staff have attended a lot of training that has been organised to improve staff skills, so they can support people and understand specific needs. EVIDENCE: We examined three staff files and all individuals completed an application form and a record of the interview and responses were maintained. A PoVA First (Protection of Vulnerable Adults) and a Criminal Records Bureau Check (CRB) were obtained. Two files contained two written references and one file sampled only had one written reference; the person had completed two days on an induction and had received a PoVA check but was awaiting a CRB. It is required that the service receives all required pre-employment checks prior to people starting work in the home, including two written references. Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 22 Examination of records and discussion with staff revealed that staff have had an opportunity to attend training for Protection of Vulnerable Adults, the Mental Capacity Act, Moving and Handling, First Aid, Healthy Eating and Catheter Care. Staff reported that the training enabled them to develop their skills in order to support people in the home. New staff are now expected to complete the Skills for Care Common Induction Standards during the first six months of employment. There were two new staff who have started work in the preceding weeks, who have just begun this induction. Senior staff reported that this would enable them to support staff through this period and ensure people had the right skills to work in the home. The number of staff on duty within the home has not been kept under review since the last visit. The home accommodates a larger number of people and a small number of people have high dependency needs. The registered person is required to carry out an assessment of risk to in relation to dependency levels, support and lifestyle and demonstrate that the staffing provided is suitable to meet the needs of people who use the service. People using the service spoke very highly of the staff and the support provided. Comments included, ‘All the staff are nice, they’re very patient,’ ‘If we are ill, the staff always look after us,’ ‘They’re so nice to us.’ Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 23 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, 35, 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is without a manager and this has an affect on the quality of the service provision in the home. EVIDENCE: The service has been without a registered manager since July 2006. Previous reports have identified that the service provider was to appoint a manager and for that person to submit an application to become the registered manager. At Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 24 present the daily management of the home is covered by two senior staff. It is required that the service provider appoint a manager. Since July 2006 there has been several temporary managers to the home and the last visit identified that the Acting Manager had addressed all outstanding requirements and improvements had been made within the standard of care and support, activities and management of the home. There is no longer an appointed manager, and this visit has identified concerns with staff recruitment, lifestyle of people using the service including activities in the home, and poor medication practices. Discussion with staff revealed the changes have resulted in poor communication within the team, poor proactive planning and uncertainty of the future. The registered person must ensure that the service is managed to support people and provided positive outcomes for people using the service in all areas. Due to the poor outcomes for individuals in relation to Health and Personal Care and Management and administration the home will be subject to a Management review by us. A management review is a key part of the enforcement process whereby we set out what we will do to make sure the care provider improves their service. The action we will take, will depend upon what effect this is having on the people using the service and how the care service provider responds. Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 25 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 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 2 3 X 3 X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 3 X 3 X X 3 Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 26 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 OP9 Regulation 13(2) Requirement The records of the receipt, administration and disposal of all medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. Timescale of 27/6/08 not met Appropriate information relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including “when required” medication to ensure that all medication is administered safely, correctly and as intended by the prescriber to meet individual health needs. Timescale of 27/06/08 not met Staff who administer medication must be competent and their practice must ensure that residents receive their DS0000004919.V367227.R01.S.doc Timescale for action 30/06/08 2 OP9 13(2) 30/06/08 3 OP9 13(2) 30/06/08 Bonehill Lodge Version 5.2 Page 27 medication safely and correctly. Timescale of 27/06/08 not met 4 OP9 13(2) All Controlled Drugs must be stored in a cabinet that comply with the Misuse of Drugs (Safe Custody) Regulations. A review of the staffing provided in the home needs to be completed to demonstrate that the number of staff available in the home is suitable to meet the needs of people who use the service. Where people are awaiting a Criminal Records Bureau Check disclosure and working with only a PoVA, two written references must be obtained and the person is continue to work under supervision until the disclosure is submitted to ensure the all staff are suitable to work with people who use the service. To ensure that people who use the service are protected staff need to receive training and support for safeguarding adults and the agreed procedures for responding to any alert. The registered person needs to appoint a manger to the home and the person is to begin the fit person process following satisfactory Criminal records Bureau Check. 23/08/08 5 OP27 18 (1) 07/08/08 6 OP29 19 (1)(a)(b) Schedule 2 07/07/08 7 OP30 18 (1)(c)(i) 30/08/08 8 OP31 8 (1)(2) 30/08/08 Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose needs to be reviewed to reflect the current activities provided in the home and the management arrangements. People who use the service are to have a contract, which is to include the fees payable and the terms and conditions of occupancy. Where a person is readmitted to the home following treatment an assessment of needs should be carried out to ensure the service could still meet the needs of the person. All staff administering medication should undergo regular assessments to ensure their ongoing competency to follow the home’s procedures correctly. All medication particularly Controlled Drugs must be stored securely so that unauthorised personnel do not have access to them. Review and update plans relating to medication to make sure that they reflect what choices people who live in the home are given about how their medicines are administered and their consent to the way in which staff administer their medicines. Where medication is administered with food and consent is not possible because of lack of capacity, records must be made of the agreement so that the way in which medicines are administered is in the best interests of that particular person. To review the activities provided in the home to ensure people have an opportunity to be involved in activities of DS0000004919.V367227.R01.S.doc Version 5.2 Page 29 2 OP2 3 OP3 4 OP9 5 OP9 6 OP9 7 OP12 Bonehill Lodge their choice. 8 9 OP12 OP22 To assess the risk for people wearing slippers to ensure they are correctly fitted and do not place people at risk. All equipment to support people with mobility is to be assessed by a competent person to ensure it is safe and suitable for the person to use. To repair or replace the cooker to a safe and suitable standard To provide suitable and safe equipment for use in the kitchen to ensure people are protected from harm. 10 11 OP19 OP19 Bonehill Lodge DS0000004919.V367227.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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.V367227.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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