Inspection on 29/02/08 for Bonhomie House

This inspection was carried out on 29th February 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bonhomie House 30/01/09

Similar services:

Flint House

Heather House Nursing Home

The Cotswold Home

Fairways

Treloar College

Rush Court

The Maypole Nursing Centre

Fir Tree Lodge

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

CARE HOME ADULTS 18-65 Bonhomie House Dodwell Lane Bursledon Southampton Hampshire SO31 1DJ Lead Inspector Christine Walsh Key Unannounced Inspection 29th February 2008 10:00 Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 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 Bonhomie House DS0000069889.V361174.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 Adults 18-65. 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. Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bonhomie House Address Dodwell Lane Bursledon Southampton Hampshire SO31 1DJ 02380 402168 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) Mr Amin Lakhani Mrs Malek D Lakhani, Dr Azim D Lakhani vacant post Care Home 78 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (0), Physical disability (0), Physical disability over 65 years of age (0), Sensory impairment (0), Sensory Impairment over 65 years of age (0) Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) maximum number of places 15 Mental disorder, excluding learning disability or dementia - over 65 years of age (MD(E)) - maximum number of places 15 Physical disability (PD) maximum number of places 78 Physical disability - over 65 years of age (PD(E)) - maximum number of places 78 Sensory impairment (SI) - maximum number of places 8. Sensory impairment - over 65 years of age (SI(E))- maximum number of places 8. The maximum number of service users to be accommodated is 78. 2. Date of last inspection Brief Description of the Service: Bonhomie is a home for adults from the age of 18 and offers a service to meet the needs of physically and sensory impaired service users and those with mental health disorders. The home also provides care for people who suffer from problems due to brain injury. The service is offered in various units throughout the grounds including nine newly purpose built bungalows, existing bungalows and the main house where staff give in some cases one to one care. Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 5 There is a hall in the grounds, which offers activities and entertainment, a newly furbished sensory room and hydrotherapy pool. The service users are encouraged and enabled to access facilities in the community, with swimming at least once a week and access to horse riding facilities. There is a mini bus available and local taxis assist with transport needs. The home is situated in its own grounds with access to the M27 very near. Fees at the home range from £378.96 to £3,792.50 per week dependant on needs and the amount of support required, The people who use the service are responsible for paying for hairdressing, chiropody, college course, holidays and contribution to outside entertainment. Bonhomie House DS0000069889.V361174.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 1 star. This means the people who use this service experience adequate quality outcomes. This site visit formed part of the key inspection process and was carried out over one day by Mrs C Walsh, Regulatory Inspector. The manager completed an Annual Quality Assurance Assessment (AQAA) document, which was returned to the Commission for Social Care Inspection prior to the visit to the home. The information obtained to inform this report was based on viewing the records of the people who use and work at the service, speaking with the residents, visitors and staff and observing care and support practices. A tour of the main house and newly built bungalows took place and documents relating to health and safety were viewed. This was the first visit to the service since the service changed its registered name Saffrondland Homes Limited to Saffrondland Homes Group. What the service does well: The home ensures the people who use the service are supported to maintain an active lifestyle that suits their needs. This includes accessing a newly installed hydrotherapy pool, a sensory room and maintaining contact with family and friends and socially engaging with their peers and the local community. The manager and staff are aware of their roles and responsibilities in respecting each person’s individual daily life choices and decisions, such as what they would like to eat, drink and the activities they would like to participate in. The home has designated kitchen staff who are responsible for devising, preparing and cooking meals for the people who use the service. The catering staff are informed of each service user’s specific dietary needs, likes and dislikes. The people who use the service can choose what they want to eat and are given an alternative if they do not like what is on the menu. The people who use the service have access to a variety of health care professionals such as GP’s, dentists, psychologists and psychiatrists. Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 7 The home continues to make improvements to the grounds and the development of purpose built bungalows, where it is planned to support people to live as independently as possible. The manager and staff are provided with training to meet the needs of the residents and they undertake an induction process followed by mandatory training. This includes moving and handling and fire safety, and specific training to meet service users needs, such as diabetes, schizophrenia and psychosis, the Mental Health Capacity Act and managing challenging behaviour. What has improved since the last inspection? What they could do better: The service provides information about the home in order that the prospective resident can make a decision to move in or not. However the home’s current Service User Guide and complaints procedure does not allow those who have a cognitive or sensory impairment to make a decision, as it is not in an accessible format. The home provides care and support to large number of people with physical and learning disabilities and these must be produced to meet their needs. Each person who uses the service is assessed prior to moving into the home and a personal plan holding care plans, risk assessments, monitoring forms and daily notes are held. However the quality and completion of these records is inconsistent and does not provide staff with the information required to deliver care and support in a consistent and individualised way. There is limited information on the person’s future dreams, goals and aspirations. In general the staff were observed to be kind, and spoke with the people who use the service in a respectful and dignified way, but some practices were observed, which did not promote or respect the dignity or privacy of those living in the home. These included leaving confidential papers in easy access of others, failing to close a toilet door whilst it was being used and watching television whilst feeding a resident. The environment of the main house is tired and worn in areas and in need of redecoration and refurbishment. It was planned in June/July 2007 to start work on the main house, however this work has been delayed and rescheduled for March/April 2008. The people who use the service are aware of forthcoming changes but were anxious of how this will affect them. A resident said Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 8 he wished there was a confirmed date. In its current condition the home does not allow for a comfortable environment and is not free from offensive odours. Despite documentation stating that the home carries out a thorough recruitment process and staff complete an application form, attend an interview and provide names of referee’s, the service cannot demonstrate fully that it has taken up the required checks and completed documentation in full, therefore placing the people who use the service at potential risk of harm. The manager demonstrated that she had a good understanding of the needs of the people who use the service and is keen to improve and develop the home to meet its main aims and objectives, but she must ensure that practices that take place in the home are of a good standard. The health, safety and welfare of the people who use the service must be safeguarded. Fire alarms and other fire safety checks must be carried out to the required standards and frequencies. 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. Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Bonhomie House provides information about the home to people who may wish to use the service, but it must consider the communication needs of the people it supports and provide information in alternative formats, in order for them to have a clear understanding of the aims and objectives of the home. The home undertakes an assessment of people’s needs before they move into the home, to establish if it can meet their needs. The home must ensure all areas of the assessment are completed, to indicate these have been considered and not overlooked. EVIDENCE: The home’s Annual Quality Assurance Assessment (AQAA) informed us that the home has a new Statement of Purpose and Service User Guide that reflects the aims, objectives and philosophy of the home and does well in only admitting new service users after a full pre admission assessment has taken place, allowing the home to understand, identify and meet all assessed needs. Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 11 This was tested by viewing the Statement of Purpose and Service User Guide, pre admission assessment of four residents, speaking with manager regarding the process and viewing comment cards recieved from residents and relatives. The Statement of Purpose and Service User Guide are displayed on the residents’ notice board and the manager said that these documents are handed to prospective residents and the resident’s representatives at the time of assessment, providing them with information about the home. Both documents give details of the aims and objectives and how and in what way the home will support them. The home supports people with brain-acquired injuries, sensory and cognitive difficulties and therefore it must consider developing the Service User Guide in an accessible format, or provide alternative communication aids to support their understanding of the home. The assessment documents used to assess the needs of prospective residents cover all areas of their assessed and current needs, including personal, cultural, social, physical, medical and mental health. Of the four personal files viewed two residents had assessments undertaken by the home and an assessment provided by the placing authority. It was noted that the home’s assessment had not been fully completed and left out information such as the persons religious and cultural beliefs and occupation and education. To ensure all the needs of the person are considered, all areas of the assessment documentation must be completed and where possible signed by the resident or their representative. This will confirm that these areas have been reviewed and not overlooked. The manager spoke of the assessment process, which includes meeting with the prospective resident, relatives, existing staff, and health care professionals where appropriate and care managers to gather information. Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home ensures each person who uses the service has an individual personal plan, but they varied in the quality of information and guidance for staff and did not always demonstrate that a person centred approach has been undertaken. This means that people may not receive continuity of care and may not have their needs met in the way that they prefer. Risk assessments are undertaken for each person who uses the service, but these must be developed to minimise risk and not to restrict residents or prevent their independence. EVIDENCE: The AQAA informed us that the home does well to complete comprehensive care plans that demonstrate their commitment to the residents assessed needs. The residents have a committee that is run by the residents and all Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 13 potential risks are reduced to their lowest level practicable to avoid limiting the residents preferred choice of action. This was tested by observing daily practice, viewing the care plans and associated documents such as daily notes and risk assessments, speaking with residents and the manager. Four residents personal plans were viewed and each resident has a personal plan of their own. These provide information on social interactions, physical and mental health care needs, personal care needs, communication, behaviours, risk assessments and daily notes. However the information and guidance for staff varied in its quality and completion, from providing clear detail on how to support a resident, to limited information leaving the person reading the information unclear on how the residents wished to be supported. Areas such as monitoring the mood of a resident didn’t describe what the staff were actually monitoring and how this should be done and there was no evidence in the care plan that staff had been doing this. The review of these plans also varied in how often the needs of the residents are assessed, some being reviewed monthly and others no evidence of review since moving into the home, which in some cases was up to three months. A resident stated he was aware he had a personal file and sometimes looked at it. The manager confirmed that residents can have access to their personal information if they wish and this is done with the support of a designated member of staff or the manager. Some of the care plans seen demonstrated that the residents had been involved in the development of them. Through observation during the course of the visit and discussion with a resident it was established that residents are provided with opportunities to make choices and decisions about their day to day life activities such as eating, drinking and entertainment. It was noted that there was limited information held in the four personal plans which were viewed, to demonstrate that the home considers these basic individual choices and decisions and other opportunities to make choices such as their preferred daily routine. The manager stated that as part of the person centred planning process the residents’ choices, decisions, wishes, goals and aspirations will be included in their plan of care and staff will be made aware of these through various forms of communication and training. As with care plans, it was noted that risk assessments were varied in the quality of information and guidance they provided. The home must ensure that risk assessments do not limit residents’ independence or freedom, but are produced in such a way that they provide residents and staff with safe guidelines. One risk assessment stated “Resident x should not be allowed to make her own drinks”, rather than explaining what support or safety measures should be in place to enable the resident to be independent to make her own refreshments. Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures the people who use the service are supported to maintain an active lifestyle that suits their needs and individual interests. The home ensures the people who use the service maintain contact with family and friends and socially engage with their peers and the local community. The manager and staff are aware of their roles and responsibilities in respect of respecting the individual rights, choices and decisions made by the people who use the service, but the practices of leaving confidential information available to all and not respecting people’s dignity and privacy must be addressed. EVIDENCE: The AQAA informed us that the home encourages the residents to utilise opportunities to develop social, emotional, communication and independent Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 15 living skills with occupational therapist in-put weekly. A range of individual, group and community based activities are provided such as personalised shopping trips, swimming, and visiting places of interest such as pubs, places of worship and the theatre. The home encourages open visiting, freedom of choice within the individual’s assessed risk taking, and they offer a nutritious and varied diet, which takes into account choices, religious and cultural beliefs. This was tested by observing practice throughout the visit in respect of activity, interactions between staff and residents, viewing activity records, speaking with residents and the head cook. The home has an activity plan which is displayed and informs the residents of various activities planned for the week such as games in the small lounge, nail painting, arts and crafts, skittles or bingo, gentle exercises to music. Videos of the resident’s choice are shown, and church services take place on alternate weeks. A record is kept of who attended each activity and the outcome of the activity for the group and for individual residents. Individual activities include attending college, gardening club and horse riding. At the time of the visit a number of individual and group activities were taking place. A resident said he was waiting for the bus to go shopping and another spoke of the holidays and events he had attended. A resident proudly showed photographs of holidays and different parties and events he had attended. A group activity was taking place in the lounge with the support of several staff, and for those who were unable to participate, one to one time was spent with the resident, chatting or being read to. The service has a large activity room where residents were observed playing pool with staff. The manager stated that all forms of activities take place in this room including parties, discos and other forms of sporting activities. The service is in the process of making the finishing touches to a sensory room where residents’ cognitive and sensory needs will be stimulated and where they can take time to relax. The home’s newly completed hydrotherapy pool and Jacuzzi is due to start being used in the next couple of weeks following its inauguration ceremony. A resident said he was looking forward to trying the pool out. The home has an open door policy in respect of visitors, who are made welcome and regularly informed of the health and welfare of their relative or friend. A resident said that he regularly receives relatives and he is supported to maintain contact with family members who have moved abroad. The manager stated that the home is reviewing its aims, objectives and vision in respect of supporting residents to develop and maintain their independence, providing them with opportunities to do so, whilst taking into account individual risks. The manager went onto say that more opportunities for Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 16 developing and maintaining independent living skills will be provided once the refurbishment of the main house takes place and the bungalows are put into operation. The bungalows are self-contained and allow for residents to undertake daily domestic tasks such as cooking and cleaning. The home must however look at its practice of ensuring the residents are afforded dignity, privacy and confidentiality in respect of personal information held about them. A resident was observed using the toilet with the door left open and confidential information regarding a resident’s personal care needs was left accessible for anyone to view. The manager took immediate steps to deal with these concerns. The cook was spoken with and appeared to have a good understanding of the needs of the residents in respect of their dietary requirements, physical needs and their likes and dislikes. He advised that he takes time to discuss these at the time the resident moves into the home. The cook produces a monthly menu that is displayed daily to inform the residents and takes into account the need for a healthy and well balanced diet. The cook said that the care staff inform him of changes to residents’ particular dietary needs and he ensures these are catered for such, as diabetics. Alternatives are provided for anyone not wanting what is on the menu. A resident stated that the meals are okay and another resident said he enjoyed the food. The practices involved in supporting residents to eat should be reviewed to ensure that this is carried out in a sensitive and caring manner. At the time of the visit a member of staff was observed assisting a resident with their meal, but it was noted that the staff member was making limited positive interaction with the resident. The resident was not informed of what they were eating and the member of staff stood over the resident whilst assisting her and allowed her attention to be diverted to what was on the television. This was discussed with to the manager, who said she would deal with the concern straight away and would review how all residents are supported to eat their meals. Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is working towards developing a person centred approach, which include caring and supporting the people who use the service with their personal and health care needs in the way that they prefer. The home ensures the people who use the service have access to health care professionals as required. The home supports people who use the service with their medication, but the medication administration practices must be improved, to ensure the risk of errors is minimised and medications prescribed for individual residents are not used for others. EVIDENCE: The AQAA informed us that the staff provide person support that is flexible and sensitive and aims to maximise the residents core rights. The residents have access to up to date advice and information regarding health care needs and there are robust policies and procedures for the administration of medication. Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 18 This was tested by observing daily practices, including the administration of medication, viewing health care documents for four residents and associated documents such as medication administration records. We also spoke with residents, a senior member of staff and an occupational therapist. A resident spoke at length about what it is like to live at Bonhomie House, which included recieving care and support in the way that he likes and prefers. He stated that the staff were kind and considerate and know his routine. “The staff are very good, they know my routine and how I like things done”. The manager spoke of how the home is working towards a person centred approach, but recognises this is in its early stages of development. Personal plans were divided in the quality of information they contained in respect of the residents personal wishes, how they like to spend their day and how they wish their needs to be carried out. The manager stated that the home has good links with primary care and specialist health care teams. Personal plans demonstrated that the health care needs of the residents are regularly monitored and reviewed, but for three of the personal plans viewed, there appeared to be inconsistency in the completion and quality of records. One resident did not have any records relating to health issues since moving in, despite health care needs being identified. Another resident’s monthly health care review chart had not been completed since they had moved in, which had been two months previously. The personal plans viewed provided evidence that residents prone to pressure sores are provided with the appropriate equipment and treatment to prevent sores developing, such as the use of pressure relieving mattresses and cushions and input from specialist nurses. Residents’ personal plans indicated that a number of health care professionals are involved in the treatment and rehabilitation of the residents. At the time of the visit a case conference was taking place that included the resident’s psychiatric team. The home has a designated occupational therapist who visits the home twice a week to assist residents and staff with moving and handling, posture, positioning, ordering and maintaining equipment, writing specific care plans and will soon support residents to use the hydrotherapy pool. The occupational therapist said that she is unable to give dedicated time to all these areas but with the assistance of the trained nursing staff, is soon to undertake specific training in the above areas. This will help care staff to ensure more time is made available to assist residents with passive movements, to prevent the rigidity that can take place. The occupational therapist confirmed that she was available to support the residents and staff with any concerns they may have. Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 19 The home has systems in place for the administration of medication. The home uses recognised medication trolleys that are secured when not in use and which hold medications for residents. These are dispensed by a local pharmacy and are individually labelled and stored. Medications are received, stored, recorded and disposed of using systems as stipulated in the Royal Pharmaceutical Guidelines. On the day of the visit it was noted that some aspects of the administration of medication was not to the required standard. Staff were observed to answer the phone whilst giving medications and left the medication trolley unattended with the keys in. It was also noted that a medication prescribed and labelled for an individual resident was administered to all residents requiring this medication at the time of administration. Only registered nurses administer medications and the nurse administering medications at the time of the visit was spoken with about the practices observed. She confirmed that she is aware of the Royal Pharmaceutical Guidelines and recognised that her current practice was not of the required standard. This was discussed with the manager at the time of the visit who said she would review medication practices of all staff and would ensure that individual’s prescribed medications are not used as general stock for all residents. Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home listens to and acts upon the concerns raised by the people who use the service, but the home must consider the sensory and cognitive needs of the people who use the service to enable them to raise concerns. The home ensures the staff receive appropriate training and policies and procedures are in place to safeguard the people who use the service from potential risk of harm. The manager must ensure she regularly monitors the care and support practices of staff. EVIDENCE: The AQQA informed us that the home has a robust complaints procedure, which is displayed and there is abuse training for staff who also have access to appropriate policies and procedures. The home recognises it could do better in this area and aims to ensure all new staff are aware of the complaints policy and the protection of vulnerable adults during their first week of induction. This was tested by viewing the homes current complaints procedure, logbook, speaking with residents, viewing “Have Your Say” comment cards and staff training records. The home has a complaints policy and procedure, which is displayed for residents to view and is provided in the Service User Guide on admission to the home. The current policy does not take into account the cognitive and sensory needs of the residents and therefore the home must consider alternative formats in order that residents can express their concerns. The home has not Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 21 received any complaints since the new manager has been appointed. A memo to staff was seen which informed them of the appropriate route to raise concerns and complaints. A resident said he didn’t have any complaints but knew he would be able to speak with the manager if he was unhappy. He went onto say that the home holds regular residents’ meetings and this is a good time to express any concerns or worries. The home has policies and procedures in place in respect of safeguarding residents from potential risk of harm. Staff receive training and are required to read polices at the time of their induction, and this is followed up by further training. Five staff files were viewed and there was evidence to demonstrate that staff had received safeguarding training. The manager spoke of how important it is to ensure the people who use the service are safeguarded from potential harm and demonstrated that she has a clear understanding of her roles and responsibilities in this area. The need for the manager to be visible and accessible to residents and staff was discussed, as was the need for the manager to observe and monitor care practices in the home. This should help to ensure care and support practices are to the required standard. Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, and 30 Quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. The service has made significant improvements to the grounds and the development of nine purpose built bungalows. The main building is in urgent need of refurbishment in order that the people who use the service live in a welcoming, comfortable and clean environment. EVIDENCE: The AQQA informed us that all residents have a room of their own and there is wheelchair access to all areas within the home and grounds. Staff receive infection control training and there is domestic support seven days a week. The AQAA also tells us that there have been many improvements to the service, including the installation of a hydrotherapy pool, nine new purpose built bungalows and landscaped garden, but recognises improvements are needed to upgrade the internal and external appearance of the main building. Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 23 The standard of the environment was tested by touring the main building, new bungalows and one existing bungalow, speaking with residents about their own rooms and the proposed changes, observing practice, viewing staff training records and speaking with the manager. The main house looked tired and worn and in need of urgent refurbishment. The manager said that a total refurbishment of the home was due to take place in March or April 2008, which will include replacement fixtures, fittings, flooring and bathing facilities. This was also confirmed by a resident who was aware of the forth-coming changes to the environment but requested that knowing a firm date would put him and his fellow peers at ease. In order for the refurbishment to take place some residents will be moved to the newly built bungalows, which have been completed to a high standard. Bonhomie House was previously part of a limited company known as Saffrondland Homes Limited. The registration of this company has since been changed to Saffrondland Homes Group, which includes the partnership of the previous owner and a number of other directors. The same issues regarding the standard of the home’s environment and residents’ awareness of the proposed changes was mentioned in the report following the inspection carried out in June 2007. That report identified that the plans to make changes were proposed to take place very shortly, as the residents had expressed concerns how the changes would affect them. After seven months there is still not a confirmed date for the refurbishment to start, and the residents’ uncertainties remain the same. The manager stated that the residents have been involved and updated with timescales and how the changes will affect them. The residents must be afforded the respect of knowing a confirmed date and the schedules of works, in order to reduce their anxieties. The grounds are kept in good order and recent landscaping of a garden area with a water feature is a pleasant addition to the home. The home has policies and procedures regarding infection control and antiseptic gel dispensers were situated around the home. Staff training records demonstrated that staff receive training on infection control. Although the home has dedicated cleaning staff who were observed at work throughout the day of the visit, it was noted that there were some unpleasant odours when touring the main home. This appeared to be due to old and worn carpets, which are in need of replacement. This was also identified at the last inspection visit, but it was stated they would not be replaced, as the home was due for refurbishment. These should be replaced, or the refurbishment should be started, to ensure residents can live in a comfortable and hygienic environment. Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home ensures the people who use the service are supported by adequate numbers of skilled staff and can demonstrate that they are taking steps to improve the quality of training. Residents are at potential risk of harm because the home has not carried out appropriate checks on new staff prior to them starting work in the home. EVIDENCE: The AQAA informed us that on commencing work at Bonhomie House staff have a job description and are inducted within their roles using the Skills for Care induction. Training for a national vocational qualification (NVQ) is ongoing and all new staff are employed according to legislation regarding references, criminal record bureau (CRB) and protection of vulnerable adult (POVA) checks. This was tested by observing daily practice, viewing training and recruitment files, speaking with some staff, and seeking the views of the residents. Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 25 The home was busy at the time of the visit as residents were undertaking various activities with staff support, such as supporting residents with their personal hygiene and health care needs, supporting residents to go out and participate in individual and group activities. Needs appeared to be being met in a relaxed and organised manner. The home has dedicated cleaning, kitchen staff and maintenance staff, which allows care staff to focus on the needs of the residents. A resident said that the staff are supportive and attend to his needs promptly when he calls for assistance. Whilst the resident was being spoken with, a member of staff checked on him because his door was closed and she was concerned as he usually has his bedroom door open. Staff are encouraged by the home to undertake a National Vocational Qualification (NVQ) in care, to levels 2, 3 and 4. Currently 24 of the staff team have achieved a NVQ. The manager was aware that the home should be achieving the recommended 50 of staff trained to this level, and should ensure there is a clear plan to achieve this. The recruitment files of four newly appointed staff were viewed and it was noted that not all the required documents had been obtained before people started to work in the home. These included references and for three staff, there was no start date or contract, to test if a protection of vulnerable adult (POVA) check was in place before they started. An application form, which was viewed, showed there were gaps in the employment history, which had not been questioned or explained. On commencing in the home the staff are inducted with the support of senior staff. The induction covers all aspects of care, the carers’ roles and responsibilities and information significant to the running of the home. During the induction process staff receive training such as moving and handling, first aid, fire safety and food hygiene. In addition they receive training specific to the needs of the residents such as diabetes, acquired brain injury, schizophrenia and psychosis, which is followed up as required. Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is run by manager and a skilled staff team who are taking steps to improve the service it provides for the people who use it, listening to their views and those of their relatives. The company which runs the home must demonstrate that the quality of the service provided is being monitored and is providing a safe place for the people to live. The manager needs to monitor care practices more closely and be more accessible to residents and staff. EVIDENCE: The AQAA informed us that a new manager has been appointed, who has completed her NVQ Registered Managers Award (RMA) and is a key trainer for the Mental Capacity Act. It also informed us that the home has a number of systems for monitoring the quality of the service, such as resident and staff Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 27 meetings, 1:1 feedback from residents, staff and relatives and audits undertaken by Southampton University for the placement of student nurses. In respect of health and safety it tells us that the home has safe working practices with associated policies and procedures. This was tested by spending time with the manager and her deputy manager, and by observing practices and interactions with staff and residents. Documents relating to health and safety and quality were also viewed. The newly appointed manager had been in post approximately six months at the time of the visit and has previous experience of working with people with nursing needs, mental health needs and learning disabilities. The manager is currently preparing to submit her application to register with the Commission for Social Care Inspection (CSCI). The manager demonstrated through the course of the day that she has a good understanding of the needs of people living in the home and her roles and responsibilities in ensuring their needs are appropriately met. A discussion took place regarding how the manager has settled into her new role and how she manages her staff. The manager appeared confident and spoke enthusiastically about her plans and vision for the future. This included the importance of ensuring the residents are treated with respect and that the values of dignity, privacy, promoting independence and opportunities to live fulfilled lives are upheld. The manager acted promptly to the concerns raised at the time of the visit, but the need to have a more visible presence throughout the service to monitor the standards of care practices, was discussed. The home undertakes an annual quality audit of the service seeking the views of the residents and relatives. An action plan is then developed and reviewed monthly. Additionally, monthly resident and staff meetings take place. The manager stated that the home is visited once a month by a senior manager in the company who undertakes an unannounced quality audit of the home, as required under Regulation 26 of The Care Homes Regulations. This regulation requires organisations who are not in day to day control of a service to appoint a person to make monthly, unannounced visits to the home. During the visit, the person should speak to residents, look around the premises and check specified records. A short report of the visit must be written and a copy of the report must be provided to the registered manager. It was noted that copies of these reports were not available and these must be made available in the home. There is evidence that the staff receive regular training in fire safety and there were fire safety notices displayed around the home detailing what to do in case of a fire. A fire risk assessment has been drawn up, but written records Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 28 required under Fire Safety legislation were inconsistent in their completion. There was no record of testing emergency lighting and the tests of the fire alarm showed they had not been completed to the required frequency since December 2007. This responsibility had been delegated to the maintenance department and the manager stated she would establish why the records had not been kept up to date. The manager is however responsible for ensuring all staff carry out their key roles and responsibilities. Potentially harmful substances were securely locked away as required by the Control of Substances Hazardous to Health (COSHH) regulations. Notices were discreetly displayed around the home reminding people of good hygiene practices and all serviceable utilities including small electrical appliances, have been regularly checked to ensure they are in good working order. Bonhomie House DS0000069889.V361174.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 Adults 18-65 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 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 1 X 2 X 2 X X 2 X Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement A written plan must be drawn up in consultation with the service user or their representative, as to how the people who use the service health and welfare needs are to be met. The plan must be made available to the service user and be kept under review. Arrangements must be made to enable the people who use the service to make decisions with respect to the care they are to receive and their health and welfare. Arrangements must be made for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home, to ensure the people who use the service receive their medication as prescribed and to safeguard against medication errors. The premises to be used as the care home must be of sound construction and be kept in a good state of repair externally and internally, and all parts of the care home must be kept clean and reasonably decorated, DS0000069889.V361174.R01.S.doc Timescale for action 31/05/08 2 YA6 12(2 31/05/08 3 YA20 13(2) 14/05/08 4 YA30 23 (2) (b & d) 31/05/08 Bonhomie House Version 5.2 Page 31 5 YA34 6 YA39 7 YA42 to ensure the people who use the service live in a home that is homely, safe and comfortable. 19 & A person must not be employed 31/05/08 Schedule to work in the care home unless 2 the specified information and documents have been obtained in respect of that person. This is to ensure that the people who use the service are safeguarded from people who are not fit to work in a care home. 26(3)(4) Visits to the home as specified 31/05/08 by Regulation 26 must be carried out, and copies of the report of the visit must be provided to the registered manager. This is to ensure that the quality of the service provided is monitored. 31/05/08 23(4)(c)(ii After consultation with the fire & v) authority, adequate & (E) arrangements must be made for giving warnings of fires; for reviewing fire precautions and testing fire equipment at suitable intervals; and to ensure, by means of fire drills and practices at suitable intervals, that the persons working in the home, and so far as practicable, service users, are aware of the procedures to be followed in case of fire, including the procedure for saving life. This is to ensure the health and safety of the people who use the service and staff. Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 32 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 YA5 Good Practice Recommendations It is recommended that the people who use the service with cognitive and sensory difficulties have a Service User Guide and complaints procedure that meets their needs. It is recommended that the home improves the skills of the staff in the home by ensuring that at least 50 of the care staff have a National Vocational Qualification (NVQ) to level 2 or higher. 2 YA32 Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 33 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. Extracts may not be used or reproduced without the express permission of CSCI Bonhomie House DS0000069889.V361174.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!