Inspection on 30/01/09 for Bonhomie House

This inspection was carried out on 30th January 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bonhomie House 29/02/08

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 18/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Bonhomie House Dodwell Lane Bursledon Southampton Hampshire SO31 1DJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janette Everitt     Date: 3 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 38 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 38 Information about the care home Name of care home: Address: Bonhomie House Dodwell Lane Bursledon Southampton Hampshire SO31 1DJ 02380402168 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Malek D Lakhani,Dr Azim D Lakhani,Mr Amin Lakhani Name of registered manager (if applicable) Mrs Karen Patricia Richards Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia physical disability sensory impairment Additional conditions: The maximum number of service users to be accommodated is 78. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) Physical disability (PD) Sensory impairment (SI). Date of last inspection Brief description of the care home 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 Care Homes for Adults (18-65 years) Page 4 of 38 care home 78 Over 65 0 0 0 78 78 78 Brief description of the care home disorders. The home also provides care for people with acquired brain injury. The service is offered in various units throughout the grounds including nine purpose built bungalows, existing bungalows and satelite units and the main house. Currently the house is in the process of being extended and fully refurbished in a staged programme and as a consequence only sixteen rooms in the house were being occupied at the time of this visit. There is a large hall in the grounds, which offers activities and entertainment, and is being used as the main dining room and communal area whilst the buildling works are in progress. The activity hall building also accommodates a newly furbished sensory room and a hydrotherapy pool. The service users are encouraged and enabled to access facilities in the community. The home is situated in its own grounds with easiy access to the M27 and is in close proximity to Eastleigh shopping centre and Hedge End village. Fees at the home range from £358.96 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. Care Homes for Adults (18-65 years) Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The visit to Bonhomie House took place on the 30th January 2009 and formed part of the process of the inspection of the service to assess the service against the key national minimum standards. The evidence to support the assessed outcomes for people who use the service was gathered from the Annual Quality Assurance Assessment (AQAA), which the manager returned to the CSCI, and information received since the last key inspection of February 2008. Prior to the visit surveys were sent to service users, staff, visiting professionals and GPs. We gathered information in surveys returned to CSCI from people living in the home, GPs, visiting health professionals and two care managers. We also spoke to a number of service users and staff at the time of this visit. Care Homes for Adults (18-65 years) Page 6 of 38 The outcome of the surveys indicated that there was a high level of satisfaction with the service and that generally residents were happy living at the home and the service they received. Evidence was also gathered from reading and inspecting records, touring the site and from observing the interaction between staff and users of the service. At the time of this visit there were fifty one people in residents, the home being registered to accommodate 78 people, owing to the disruption of the home whilst building works are in progress. None of the service users were from an ethnic minority. The deputy manager assisted us with the inspection, the registered manager not being on site at the time, and the operational manager was also present for part of the day. What the care home does well: The manager and deputy manager undertake a full care needs assessment for all prospective residents, before a place at the home is offered, to ensure the home can meet their care needs. Surveys returned from service users generally told us that service users had been fully involved with the decision to come to live at the home and had been given information or visited the home before they went to the home to live. Observations of the interaction between staff and service users and relationships within the home would suggest that service users are treated with respect and their right to privacy was upheld. A survey returned from a care manager commented that In my observation the clients privacy and dignity is being respected. Care plans detail the service users preferences of how they wish to undertake their activities of daily living in a way they choose to do so. These are kept in the individual bedrooms. Service users health care needs are met and the home has a GP visiting the home who has commented on having good relationships with the home and that the home does a good job and supports clients with exceptionally complex physical and mental health needs Service users are provided with a varied programme of social activities and are able to choose when they wish to participate. Service users are supported to go out into the local community and are provided with transport to do so. Surveys returned from service users all indicated that they are able to choose what they do with their leisure time and how they spend their days. Visitors are welcomed at the home at any time. The chef has created a varied and nutritious menu over a four week period and there are choices at every meal time. The cook on duty that day told us that she is familiar with the service users likes and dislikes and that they can choose whatever they would like and are always offered alternative meals. Service users spoken with said that the food provided was very good and they were offered a choice at each meal. Service users are able to choose where they wish to eat their meals. The parts of the home that are in use currently and include the bungalows and satellite buildings, of those visited, they looked clean, homely and well maintained and residents had their own belongings and had personalised their living space. Service users spoken with said that they liked their rooms. Surveys returned from the service users told us that they know the procedures to follow should they wish to make a complaint. Those spoken to said they would go to the office if they wanted to talk to someone about a concern. The home has procedures in place for the protection of vulnerable adults and staff have received training in the prevention of abuse. Staff members spoken with knew the procedures to follow should abuse be suspected. Care Homes for Adults (18-65 years) Page 8 of 38 Staff receive the training required to do their jobs and have regular supervision sessions with the registered manager or the senior nurse. The service has a comprehensive quality assurance system in place and seeks the views of the service users and other stakeholders and have taken action on any issues that have been highlighted in the results of the analysis of questionnaires returned. The management have fully involved the service users with the upgrading of the house and environment and have been able to choose furniture and how they want their rooms. Service users and relatives had been fully informed of the changes and the progress of the works at residents and relatives meetings and via letter. What has improved since the last inspection? Each person has individual care plans in their rooms with details of how they wish their care to be undertaken. These are now signed by the service user or representative, if possible, as evidence of their involvement and agreement with what is recorded. The care plans are updated at each review and service users are asked on the questionnaires distributed to them, if they wish to view their records. A new care planning is in the process of being transferred to a computer based system. The service users will continue to have paper records to enable them to have access to their files when requested. The home has installed a new system for the management of medication. The pharmacist supplies the home with a monitored dosage system (MDS) for all service users and the nurses told us this is a much safer system for the management of medication. Medication prescription charts are audited monthly to ensure that nurses administering the medication are following the procedures and that a signature or code is inserted to indicated if the person has taken their medication or reasons for it not being taken. All other records were completed appropriately. The home ensures that all appropriate checks are taken up during the recruitment process and received before the person commences employment. The operational director visits the home monthly and reports on her findings and records of this are left in the home. Fire safety and the testing of the equipment and systems are now undertaken at appropriate intervals and records are maintained in the fire log. During the extensive building works the home has an environmental and fire risk assessments that are continually reviewed as changes to the building takes place. The service has all the health and safety precautions in place for the safety of the people using the site. The home is visited monthly by the Hampshire fire and rescue officer to ensure that all fire regulations are being met. The service has its own fire officer who Care Homes for Adults (18-65 years) Page 9 of 38 also visits the site monthly. All staff have received fire training and the procedures are reviewed as changes take place. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 38 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users needs are fully assessed and they are given the Statement of Pupose and Service User Guide at the time of the assessment to ensure the home can meet their needs and for an agreement to be reached about them going to the home to live. Evidence: The home carries out an individual needs assessment prior to service users moving into the home. The home receive referrals from other parts of the country and the deputy manager told us that she and the manager endeavour to always visit the person in their current environment, which can be hospital, other care homes or in their own homes. There is a clear admission process and assessments, which were on file at the home. Four service users records were case tracked. The files demonstrated that assessments are undertaken by the manager with the deputy manager, using a needs Care Homes for Adults (18-65 years) Page 12 of 38 Evidence: assessment form that covers all areas of their assessed needs and includes information on medical history, personal history, any known risks, relationships, health and physical abilities, washing, dressing, bathing, showering, medication, behaviour, day routine, night routine, likes and dislikes, diet, sight, hearing and continence. The home also receives comprehensive social care needs and healthcare assessments from other professionals involved in the placement and these were also seen on the service users files. The deputy manager told us that sometimes when meeting the prospective resident, relatives, care managers and health care professionals are also present to enable as much information as possible to be shared about that persons needs. The information gathered from the pre admission assessment, forms the basis of the service users care plan. Once the assessment had taken place it is then discussed with other members of staff to ensure that the persons needs can be met within the environment of Bonhomie. The home encourages pre admission visits from potential service users and families and makes every effort to be thorough in arranging the package of care to suit that persons needs before they go to live in the home. The deputy manager told us that currently the home is assessing a potential service user from the north of the country and they have visited the home once and are going to visit the home again with the family in the near future, and for the home to be able to meet their needs, a day centre has to be arranged before they can transfer to this area. Eleven of the thirteen surveys received from service users indicated that they had received sufficient information about the home before they moved to Bonhomie and that they had been fully involved with the placement. The Statement of Purpose and Service User Guide has been reviewed as changes to the environment have been made and give details of the aims and objectives of how the home will support the service users needs. The operational director acknowledges, that to fully support people with brain acquired injuries, sensory and cognitive difficulties, the information must be produced in other formats to support their understanding. She told us that the information is in the process of being produced in a DVT format and other communication systems and will be done when all the alterations to the home have been completed. Care Homes for Adults (18-65 years) Page 13 of 38 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users know their assessed needs are reflected in person centred plans of care and that they are involved in the development of the plans to ensure they receive the care they need in the way they wish it to be carried out. Service users are supported to make decisions about their lives. Risks are identified in the care plans that inform staff about how these risks are to be minimised. Evidence: The AQAA stated that comprehensive person centered care plans are written and demonstrate the homes commitment to meet clients needs and are written with full involvement of the service user and or their family. The care plans set out restrictions on choice and freedom which has been agreed with the service user, family and care manager, if appropriate, prior to their going to live at the home. Care plans are reviewed three monthly or sooner if necessary. Care Homes for Adults (18-65 years) Page 14 of 38 Evidence: Care plans were viewed for four service users and these had information on personal history, relationships and social contacts, behaviour, moods, washing, dressing, undressing, bathing, continence, general appearance, oral hygiene, daily routine, night time routine, likes and dislikes, diet and food preferences. It was also observed that for some residents the physiotherapist had written a care plan to describe exercises to manage the risk of contractors of the legs. Each service user has a copy of their care plans in their rooms that describe their daily routines and how they like those routines carried out. A sample of these were looked at and they had been signed by the service user. Service users spoken with were aware of the care plans in their rooms and said they agreed to what the care plans said. Reviews of the service users needs take place with the service user, family, care manager, primary nurse and other health professionals involved in the care of the service user. These people are invited to the meeting or to give comment. The deputy manager told us that before a review meeting a folder is made up that consists of care plans, risk assessments, current health status, therapist reports and any special needs stated, to enable the review meeting to have up to date information about the service users care needs and how they are being met. There was evidence in the service users files of care review reports and these demonstrated that a multidisciplinary approach to reviewing the care needs is taken with reports seen from the occupational therapist, physiotherapist and the mental health team. Care plans are in the process of being put on a computer system in line with the other homes in the group. Bonhomie, being a large home, it is taking time to do this and to train staff as this process is gone through. One of the four service users care plans being tracked, had been stored on the computer but a copy of the care plans were also printed out for accessibility. The deputy manager informed us that printed copies of the care plans would always be available so that service users have access to them. Generally the care plans and documentation for each service user is comprehensive. Some of the residents have been living at the home for many years and the files have gathered a great deal of information. The deputy manager told us that all files will be reviewed and out of date information be archived for storage. Once the electronic care plans are in place all service users will have a folder containing a copy of current care plans and current information. The surveys received from service users and those spoken to on the day of this visit told us that they are involved and have their say with the care planning process and Care Homes for Adults (18-65 years) Page 15 of 38 Evidence: that they are happy with their care. The surveys also told us that they are able to make their own decisions about what they want in their daily lives and where they wish to go. They told us they have been involved and kept upto date about the alterations to the house, and their opinions have been sought about their choice of rooms and what they want in it and how they want it arranged. Observation throughout this visit and talking to the service users, established that residents are provided with the opportunities to make choices an decisions about their day to day life such as preferred daily routines of their activities of daily living and where they choose to spend their days. Observations made of the interaction between service users and staff indicated that the staff have a good understanding about the preferred routines of the service users and interact well with them. An example of this was during this visit a discussion took place between the operational director and the deputy manager about a service user who wishes to take control of all of their money and to store this in their room. This is being respected and a safe is being fitted in their room, for which they will hold a key. It was suggested that a copy key be kept at head office as a precautionary measure in case the key was mislayed. The regional director told us that it is not always possible for service users to open bank accounts easily as they do not always have the necessary documentation. The deputy manager told us that a number of service users have families involved in their care and support them to make decisions about their lives. Two service users use a local advocacy service to support them with their choices in life. The care plan documentation identified individual risk assessments with care plans written to minimise and manage the risks. An example of this was for smoking. The care plan described the actions to be taken by the service user and staff to ensure that the service user could smoke a cigarette when they wished to but with controls in place to ensure their safety and the safety of the other service users. Also evidenced in the care plans were risk assessments for two service users, who live in the bungalows, having been assessed by the occupational therapist to make a cup of tea for themselves with a care plan written to guide this. All service users have individual environmental risk assessment in their care plans. Currently their are obvious risks factors to do with the environment and the major building works that are in progress in the old house. The surrounding grounds are also Care Homes for Adults (18-65 years) Page 16 of 38 Evidence: affected. The home has a risk assessment for the site and clearly defined areas that are closed off and not to be entered. The areas of risk outside in the surrounding grounds are fenced off and clearly marked as hazardous. A closed in walkway has been constructed between the house and the main activities hall, to ensure service users can transfer between the buildings in a dry and safe environment. Care Homes for Adults (18-65 years) Page 17 of 38 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of 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. Service users independence and individual choices are promoted within their daily routines. Servicew users are offered a nutritious and varied diet. Evidence: The AQAA stated that the home encourages the service users to utilise opportunities to develop social, emotional, communication and indpendent living skills with occupational therapist and physiotherapist input weekly. The home has a range of individual group and community based activities provided for the service users, such as shopping, visiting the the theatre, cinema, swimming pool, pubs and places of Care Homes for Adults (18-65 years) Page 18 of 38 Evidence: worship. The home encourages open visiting, freedom of choice within the individual assessed risk taking. A tour of the site and observation throughout the visit confirmed that the home does provide a range of activities to suit each service users needs and choices. The care plans document a good social history for each service user and what their preferred recreational activities are. The home is in the process of putting together booklets for each service user titled This is your Life and details the persons past life and gives information that can be shared with carers to enhance the interaction between them. The home has a large activities hall on site, which is currently being used as a dining area whilst the building works are in progress. A kitchen area is used as the servery for the meals being served in this area temporarily. However, this area remains the hub of any activities, where large gatherings are held such as discos, parties and sporting activities. It was observed that several activities were taking place with a number of staff in attendance. For those unable to participate in group activities, one to one activities were taking place with carers and service users, other service users were sitting around the table ready for their lunch. The notice board in the hall identified the activities programme for the week, although it had also been used as a score board for a game the residents had played that morning. There were many photographs displayed on the walls of past events and outings. The home is fortunate to have a mini bus that is available most of the time to take service users into the community to attend various outside activities or to attend other appointments. Service users were spoken with at this time. One service user could not communicate verbally but had a communication book which was used to tell me that he was happy and enjoyed living at the home. Another service user had a communication aid and was able to respond quickly to questions and comments. The home has also installed a hydrotherapy pool room, which was visited. This was due to be commissioned last year but has yet to be commissions owing to the extensive building works on site, which has left the fire exit to this room temporarily blocked. The physiotherapist was spoken with and she told us that once the building works are completed the pool will be opened up and then she intends to train staff to use the pool for each individual service user who wishes to and is able to use the pool. The activities centre now houses a sensory room, which has been opened recently where service users cognitive and sensory needs can be stimulated and where they can take time to relax. The deputy manager told us that there are no service users attending a college currently as the local college has stopped the outreach service, but a music group is Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: still being supervised by one of the tutors. Two service users have their own computers. One was spoken with and he informed us that he is only in a temporary room whilst his is being completed and once he has moved in he will be able to reconnect to the broadband for his computer to keep in touch with friends, although he commented he must monitor the cost and budget for this. A record is kept of who attended each activity and the outcome of the activity for the individual and the group. The home seemed a busy place with a great deal of activity going on throughout the day. Surveys returned from service users told us that they always make the decision about what they do each day and they do as they choose during the day and evenings every day of the week. The home has an open visiting policy and visitors are made welcome to the home at any time. Service users can meet their relatives in their rooms or in the communal areas, although currently that is the activities hall. The home has built relationships with relatives and friends of the service users who have been resident for a number of years and are confident that service users are well supported to maintain contact with their friends and families. The AQAA states that the home has specialist guidance available for personal relationships if required. Two of the service users have formed a special relationship and this has been guided and supported by the home and the care manager as to their decisions and choices as to how the relationship has developed. The service users are encouraged to develop and maintain independent living skills. The occupational therapist will assess the living skills and those living in the bungalows, which are self-contained, and allow the service users to assist with the domestic tasks. Until the building works are completed this is difficult as some of the bungalows are accommodating two service users, where normally they would be sole occupancy. The kitchen was visited and the cook spoken with. The kitchen was clean but is surrounded by outside building works which has closed off one of the windows. However, this has not prevented the cook from being able to produce the meals of choice and a nutritious diet. The cook spoken with has worked at the home for some considerable time and is familiar with all the service users likes and dislikes and will produce whatever they want. The full time chef who was not on duty at the time of this visit, will speak to each new resident to find out about their food preferences. The menu is displayed in the activities hall and this evidenced a choice of meals with alternatives available. The cook said that snacks are available all day. The lunch time Care Homes for Adults (18-65 years) Page 20 of 38 Evidence: meal was observed and was well presented and nutritious. Those meals that were pureed were done so in separate portions for the service user to see the colours and taste the different textures of the food. There were a number of service users who needed help with their food. This was observed in one of the bungalows and the nurse assisting was sat with the service user, who was eagerly accepting her food, discussing the meal with her. One service user was observed to be giving the cook a meal to heat up as he had chosen to buy his own ready made meal. Records of what service users eat are maintained. Two service users were being fed via a tube and the care plans demonstrate that a dietitian has been involved with monitoring their nutritional status. Service users weights are recorded monthly and if a problem is identified a food chart is kept to monitor their intake and a risk assessment is undertaken and a GP referral will be made if a risk has been identified. Service users communicated with confirmed that they enjoy the meals. The AQAA states that religious and cultural dietary needs are catered for if requested. The deputy manager told us that the home was not accommodating any service user with a special dietary need through culture or religion. Care Homes for Adults (18-65 years) Page 21 of 38 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a person centred approach in supporting the people who use the service with their personal, emotional and health care needs in a way that they prefer. The home supports the people who use the service with their medication and comply with the procedures for the safe management of medication. Evidence: The AQAA told us that the staff provide personal support that is flexible and sensitive at all times taking into account the preferences for clothes, hairstyles and personal appearance. The service users have access to advice and information regarding their health care needs and there are robust polices and procedures in place for the administration and management of medication. The care plans describe the level of personal support each service user needs. The care plans that were in the service users rooms described how the service user liked their personal needs to be met and their preferences of how their routines are carried out. Service users spoken to said the staff were good and that they were supported Care Homes for Adults (18-65 years) Page 22 of 38 Evidence: with their care how they chose to be supported. One service user said he chose to have his breakfast late and that he would have his lunch at a later time and this was being respected. Service users were observed to have their own individual style and chose what clothes they wore and if they wore make up and jewellery. A service user spoken to told us very happily that his dad had given him a hair cut the previous day and that he did not much hair left. The home employs a mixed gender and mixed culture of staffing. The deputy manager told us that there were no service users specifying which gender carer they preferred. The deputy manager told us that the home has good links with the primary care and specialist health care teams. Care plans describe the health care needs of the service user and that they are regularly monitored and reviewed. All visiting health professional visits are recorded in the care plans. The GP visits weekly for a clinic and sees service users who request to see the doctor or who are assessed as needing a medical review. A survey received from the GP commented that he considers he has a good relationship with the clients and staff and together they make things happen. Surveys distributed by CSCI to visiting professionals and were returned said. The clients have extraordinary needs and within the financial constraints a good job is done. I have a good relationship with the clients and the staff and the service copes well with the clients complex needs. With regards to the service user I monitor, who has complex needs, the service provides flexible care to meet their needs. They monitor the health and social care need and responds quickly and appropriately to any concerns. The home has good working relationships with outside agencies and family of service user and ensure concerns are responded to and needs are met. Once the building works are complete this should improve provision. It is my observation that the clients privacy and dignity is respected. The service has managed to accommodate my clients diverse needs and provides an appropriate service. The service has a person centred approach, multidisciplinary working and liaises with other professionals The psychiatrist and community psychiatric nurse (CPN) visit the home. They are based close to the home and will visit when requested and will notify the home if they are visiting. The home has a designated occupational therapist and physiotherapist who visit the home weekly to assist service users and staff with moving and handling, posture, positioning and ordering and maintaining equipment. The care plans demonstrated that those service users who were at risk of pressure sores were provided with the Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: appropriate equipment such as profile beds, pressure relieving mattresses and cushions and treatment prescribed to prevent sores developing. The physiotherapist or occupational therapist will write specific care plans and these were evidenced in the care plans viewed. The physiotherapist was visiting the home at the time of this visit. She told us that she assesses mobility and moving and handling and will be supporting and be training staff when the hydrotherapy pool is opened and in use. The service users have the availability of a visiting chiropodist, a dental clinic locally or one who will visit the home if required to do so. The home has systems in place for the administration of medication. The home has policies and procedures to guide practice and were viewed by us and noted to have been reviewed recently. The home has recently changed the medication system to a monitored dosage system (MDS) which is supplied by a large pharmacy. The nurse spoken to told us that this system is much safer for the person administering it. The main house has a room that the medication and trolley are kept locked in. The bungalows and satellite rooms each have a locked environment that medication is stored in and this is administered and managed by the registered nurse who is in charge of that area each shift. The medications are administered by registered nurses only who has received training from Boots on this system. The medication administrating sheets (MAR) were viewed and had been documented appropriately. There was evidence that medication prescribed on an as needed basis (PRN) that care plans had been written to describe the trigger factor to observe for when PRN medication should be offered. It was observed that the medication trolley stored individual (PRN) medication for each person it had been prescribed for. Controlled drugs were stored appropriately and safely. The controlled drug register was viewed and checked and the balance documented in the register matched that of the stock held. The medication fridge was clean and temperatures were monitored and recorded daily. Medication storage cupboards were observed and were clean and tidy with no evidence of stock piling of medicines. The nurse told us there were no service users choosing to self-medicate The home has a contract for the disposal of waste medication and this was seen by us with the records of the medication disposed of and the signature of the person taking the medication away. Care Homes for Adults (18-65 years) Page 24 of 38 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In general service users feel their views are listened to and acted on and they are protected from abuse. Evidence: The AQAA states that the home has a robust complaints procedure that is displayed on the notice board and is also sent out with contracts. The complaints procedure is also contained in the Statement of Purpose. Currently the complaints policy and procedure does not take into account the cognitive and sensory needs of the current service users and the home is considering how this may be addressed by producing this in Makaton and on DVT. The fifteen surveys Have your Say returned from service users indicated that most service users know who to go to if they have a complaint. For those who indicated they did not know, the carer had stated that they had informed the service user of his rights to complain and how to do this. A service user spoken to said they would go to the manager or deputy if they were not happy. The deputy manager said that the manager and herself have an open door policy and she reports that the service users are not hesitant in coming to the office to discuss an issue if they are not happy. The deputy said that the home has good relationships with relatives and the management are always available to discuss any issues that arise. The home has a complaint log which was seen and recorded one complaint since the Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: last inspection which was resolved within the 28 day timescale. No complaints have been received by the CSCI since the last inspection. The home has a Whistle Blowing policy that all staff are made aware of and their accountability and rights to protection. The AQAA states that the home makes available, access to advocacy and interpreter if requested. The home has policies and procedures in place in respect of safeguarding service users from risk of harm. Staff receive training and are required to read the local authority procedures for the safe guarding of vulnerable adults, at the time of their induction and this is followed up by further training. The induction programme records and staff training matrix evidenced that this has taken place. The AQAA records that seven safeguarding referrals have been made to social services over the last year. Four of these have been investigated and concluded. The CSCI have been involved in three of the issues which have been concluded. The home does use restraint in the form of bed rails or lap straps and this is undertaken within a risk assessment framework and documented in the care plans the reasons why they are used and any discussion that has taken place with the service user or their relative. The deputy manager told us that most of the service users monies was being managed by the relatives. For those who monies are managed by the organisation, their allowances are paid into head office from which the monies are distributed individually to the appropriate service users and they sign for these as evidence that they have received the monies. These records were seen by us and demonstrated a straight forward recording system for monies in and monies out with a signature of the service user on receipt of their money . Most service users have bank accounts and money is paid into these directly. The home only keeps small amounts of monies for service users. A sample of records were viewed and the records balanced with the sum of money being stored in the individual containers that are kept in a secure environment. There is a court of protection for one service user and money is distributed to the home for the service users expenses Care Homes for Adults (18-65 years) Page 26 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff are endeavouring to make the home as clean and comfortable as possible whilst the building of the extensiosn and refurbishment of the home is in progress. Infection control systems and training are in place. Evidence: The AQAA states that the home provides a homely comfortable and friendly environment during the refurbishment as is practicably possible. The site of Bonhomie consists of the large house, bungalows and satellite rooms next to the large activities hall that houses the hydrotherapy pool and the sensory room. The whole site has been disrupted during the extensive building works and refurbishment programme and therefore there are no areas of the home that have not been affected in some way of other. The large house is in the process of being refurbished and extended. One half of the house is affected whilst the other half remains occupied and this will reverse within the next two months when service users start to move into their new rooms. The programme for the refurbishment and extending of the other part of the house will then commence. The service has not taken any new admissions for some time and the outcome is that there are currently only 51 service users in residence. Some residents Care Homes for Adults (18-65 years) Page 27 of 38 Evidence: from the house, whose rooms are in the first phase of the refurbishment programme, have moved to the bungalows and are sharing accommodation with one other service user. The deputy manager told us that this has been done in full consultation with the service users and their significant others and that they have ensured that the service users have been in full agreement with whom they are sharing. The service users have been well informed about the changes and a large plan of the building works had been displayed on the old dining room wall for a while before the works began. This generated a lot of questions from the service users and their relatives and the manager has written to all relatives informing them of the proposed changes. Service users spoken to said they are excited about moving into new rooms and having all new furniture and new facilities. The operational manager told us that she considers the service users and relatives have been constantly informed about the changes and comments from them have been considered. The project has been being planned for some years and therefore every aspect of the programme has been considered. Risk assessments are in place for the whole site and a Hampshire Fire and Rescue officer visits the site once a month to monitor safety. The home has appointed their own fire officer who is also monitoring the site regularly. The site was toured and new areas viewed. The home will be divided into smaller groups with a dining room and lounge to service a number of rooms in specific areas of the home. The plans and vision for the home predict a transformation of the site with more of a small community village feel to the home. The service users continue to have access to the parts of the site they would need to go and the building works does not appear to inhibit their movements around the home as the building areas have been boarded up and fire curtains and boards erected from the roof space to the ground floor. A new laundry is to be erected. Currently the laundry is a large wooden hut in the grounds of the home., and although fuctional is not fully fit for purpose. All bedding and household laundry is sent to an outside contractor with only personal items of clothes are laundered in the laundry. This will change when the new laundry is built, it is anticipated that all laundry will be washed on site. The kitchen is to remain in its current position and will be the last area of the home to be redecorated. The surrounding gardens of the bungalows have been landscaped with a water feature in the courtyard. It was observed that there are various items of metal sculpture Care Homes for Adults (18-65 years) Page 28 of 38 Evidence: constructed of pots and pans and general metal objects around the grounds that are reported to be musical instruments used by the service users when the BBQ season is in progress. The home has a maintenance team who are responsible for the day to day repairs to the home and ensure that all fire alarms and equipment are tested at appropriate intervals. The areas of the home were observed to be as clean as possible in the main house considering the dust that must circulate in the air. The bungalows were visited and were clean. A group of cleaning staff were observed to be in this area. Surveys returned from service users indicate that they consider their environment to be clean and fresh. The home has policies and procedures regarding infection control. Infection control training is part of the induction and annual mandatory training and this was evidenced on the training matrix. Hand washing facilities and protective aprons and rubber gloves were observed to be available in appropriate areas. It was observed in one bungalow that a cleaning liquid had been left in the kitchen area. The senior carer was spoken with and acknowledged this as a mistake and put the bottle in a locked environment. Care Homes for Adults (18-65 years) Page 29 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures the residents are supported by sufficient numbers of skilled and competent staff iwho have undergone training. The service users are supported and protected by the homes recruitment policy and practices. Evidence: Observations of the relationships and interaction service users have with staff were observed throughout this visit. It was observed that the service users felt relaxed enough to chat to staff and interact with them in a friendly way and that staff were knowledgeable with their care needs and how they wished to be interacted with. Service user surveys returned to CSCI told us that service users consider the staff always treat them well and listen and act on what they are saying. On the day of this visit the numbers of staff on duty were sufficient to meet the service users needs. The rota indicated that three registered nurses were on duty throughout the 24 hours period with 24 carers on the a.m. shift, 20 the p.m shift and 13 during the night with 3 extra during twilight hours until 1100p.m. These numbers of staff do include those that have been funded for one to one care and some who have two to one care. The site is divided into three areas, the house, the bungalows and the Care Homes for Adults (18-65 years) Page 30 of 38 Evidence: satellite accommodation so that one registered nurse is always allocated to one of these areas throughout the twenty four hour period. The home employs separate domestic staff, a cook, kitchen assistant, a laundry assistant, a maintenance team. The registered manager and deputy manager are also on duty five days a week. The deputy manager told us that agency staff are used every day but they are supplied by a regular agency and the same people attend the home and they are familiar with the service users care and integrate well into the staff team. The operational manager told us that the home is anticipating using less agency staff in the near future as they are liaising with the local job centre and hope to recruit more local staff, and that the organisation is on a continual recruitment drive to recruit more permanent local staff into the homes. The AQAA informed us that all staff commencing work at Bonhomie House receive a job description and are inducted within their roles using the skills for care induction. National Vocational Qualification (NVQ) training is ongoing and all new staff are employed according to legislation regarding references, criminal record bureau (CRB) and protection of vulnerable adult (POVA) checks. Three staff files were viewed. These demonstrated that newly recruited staff undertake an induction programme based on the Skills for Care induction training and this is guided by a book that staff work through and are signed off by their assessor or mentor. Two of these induction booklets were in the staff files completed. This induction programme along with the buddy system used with all new staff, would allow staff to gain an understanding of the service users needs over the induction period of twelve weeks. The induction programme covers all aspects of care and the carers roles and responsibilities and information, significant to the running of the home. During induction the staff receive training such as moving and handling, first aid, fire safety and food hygiene. There was also evidence of staff training in specific needs of the service users such as diabetes, acquired head injury, schizophrenia and psychosis. The home is also issuing a new corporate booklet titled Practical Steps for New Staff members and volunteers and is an information booklet on specific policy and procedures in relation to health and safety, security, first aid, smoking and the use of mobile phones. The home has a training programme in place for the coming year and this was seen by us. It was observed to include all mandatory training. Staff files evidence training certificates for various training sessions such as COSHH, mental health act, osteoporosis, emergency life support, diversity and equality. The staff nurses spoken with said the staff have various opportunities to attend training to maintain their professional portfolios and are encouraged to do so. They also confirmed that they receive regular supervision from the manager. Care Homes for Adults (18-65 years) Page 31 of 38 Evidence: The AQAA reports that only 8 of the care staff have achieved NVQ level 2 and above qualification. The deputy manager acknowledged that the home is not reaching the expected standard of 50 of staff trained to an NVQ level 2. The deputy manager told us that the home is endeavouring to recruit more local staff who will be encouraged to undertake NVQ training. Currently there is one care staff undertaking their NVQ level 3 and 2 requesting to undertake the level 2. The operation manager said that training is discussed at interview and the home would like to recruit staff who have achieved this qualification. Supervision and appraisal records were in the notes of staff tracked and these evidenced that training needs are discussed at this time. A sample of recruitment files were viewed. ( AR JM DC). These staff were more recently recruited and all the necessary checks for CRB, POVA and two written references had been received. The application form did not evidence any gaps in employment history. The records demonstrate that the home employs a mixed gender and mixed cultural workforce, and service users may indicate if they wish to be attended by the same sex carer which would be documented in the care plans and respected. The deputy manager told us that currently, none of the service users have a preference for a particular gender carer. Care Homes for Adults (18-65 years) Page 32 of 38 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures the service users live in a home that is well managed, which is open and inclusive and is safe to live in. Evidence: The AQAA states that the home operates in an open, positive and inclusive atmosphere with good leadership. The registered manager is a registered general nurse and a registered mental health nurse and has completed her Registered Managers Award (RMA). She has previous experience of working with people with nursing needs, mental health needs and learning disabilities. The manager has now appointed a deputy manager to support her management role. The manager continues to update her knowledge and delivers all the mental capacity act training to all her staff. The manager was not present throughout this visit and the inspection process was assisted by the deputy manager and operational manager. Observing the relationships Care Homes for Adults (18-65 years) Page 33 of 38 Evidence: and interaction between the deputy manager and the service users, it was evident that she is very familiar with their special needs and has good relationships with them having been at the home for a number of years. She demonstrated good communication skills with those who had communication problems and was eager to show us various communication systems used by some service users to communicate with. One service user was eager to show us how his worked and the system enabled him to communicate and respond to our questions and he told us he was happy living at the home. The manager and deputy have an open door policy and service users are aware of this. The deputy manager told us that the service users feel confident to come to the office to voice their approval or disapproval of something and it gives them the opportunity to discuss any other issues. The home undertakes an annual service audit that is an annual review based on the AQAA with systems and records being audited at stipulated intervals. An action place was seen by us of the audits that are to take place in the coming year. Questionnaires are distributed to service users, relatives and other stakeholders. The results are analysed and published and these were viewed by us and told us that generally there is a high level of satisfaction with the service. The operational manager visits the home regularly and once a month writes a general report which is kept in the home and seen by us. The residents have a monthly meeting and one of the residents is a spokes person. It is at these meetings that issues can be discussed, the progress of th building work, being the main topic currently and service users are kept well informed of the changes. Staff meetings are held monthly. A sample of servicing certificates for systems and equipment were viewed. These were observed to be current. The fir log was viewed and this demonstrated that the fire alarms and equipment are tested and serviced at appropriate intervals. There were records that the fire alarm had been activated by the toaster on occasions and these are recorded appropriately and used as a fire drills for the staff. The training matrix and staff records demonstrated that staff receive regular fire training. The building has a fire risk assessment that has been drawn up with advice from the Hampshire Fire and Rescue officer. The fire officer visited the site when building works Care Homes for Adults (18-65 years) Page 34 of 38 Evidence: commenced and contacted CSCI to raise concerns about fire safety issues that had not been addressed initially. As a result of this visit and subsequent visits to the site the appropriate fire safety precautions were put in place. He now visits the home monthly to inspect the building works to ensure that the appropriate fire precautions are in place as the building progresses, for the safety of the people living in the house and staff. He visited the home on the day of this visit and reported to us that he is completely satisfied that the home is reviewing all the necessary assessments and precautions for the safety of the people on site. The home has an appointed fire officer who also visits the home monthly and is available for adivce and to review the fire risk assessment as and when it changes. The operational manager told us that the manager receives a report each day from the project manager as to area the builders have been working and how they have left it secure and safe. The service has individual room risk assessments and these are in the service users care plans. The accident records were viewed and these are completed appropriately. All incidents are reported to the CSCI on Regulation 37 reports. Care Homes for Adults (18-65 years) Page 35 of 38 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 36 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 38 of 38 - 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!