Inspection on 22/10/07 for Breadstone House Care Centre

This inspection was carried out on 22nd October 2007.

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

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

Other inspections for this house

Breadstone House Care Centre 28/01/09

Breadstone House Care Centre 29/09/08

Breadstone House Care Centre 25/06/08

Breadstone House Care Centre 30/11/06

Breadstone House Care Centre 16/03/06

Breadstone House Care Centre 22/09/05

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

CARE HOMES FOR OLDER PEOPLE Breadstone House Care Centre Breadstone Nr Berkeley Glos GL13 9HG Lead Inspector Sharon Hayward-Wright Key Unannounced Inspection 22nd October 2007 11:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Breadstone House Care Centre Address Breadstone Nr Berkeley Glos GL13 9HG 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) 08453 455782 Blanchworth Care Homes Ltd Mrs Denise Rose MacKereth Care Home 40 Category(ies) of Dementia - over 65 years of age (40) registration, with number of places Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th November 2006 Brief Description of the Service: Breadstone House Care Centre is a registered Care Home with Nursing. It is registered to accommodate older people with dementia. The home is situated off the A38 Gloucester to Bristol road and is approximately 20 miles from Gloucester. It is a detached house situated in attractive grounds. The communal areas are situated on the ground floor and include 3 lounges and a dining room. There are 25 single bedrooms (7 with en-suite) and 9 double bedrooms. Current fees are £456.00 to £700.00. Less any contributions from the Registered Nurse Care Contributions Scheme (RNCC). Hairdressing, chiropody, escort and personal toiletries are charged extra. The home makes information about the service, including CSCI reports available to people through a Service User Guide and Statement of Purpose available in the home. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector carried out this inspection over two days in October 2007. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes in to account the views and experiences of people using the service. The deputy manager was available during the inspection as were other members of the home team. A total of 25 standards were inspected. People who use the service where able were spoken with to ascertain their views on the care and services provided. Surveys were sent to relatives/representatives of the people living at the home prior to the inspection to obtain their views. The comments received from the surveys returned and from speaking to people during the inspection have been used in the report. We undertook a thematic inspection prior to this key inspection and the results from this have also been used in this report. The deputy manager and care staff were spoken with throughout the inspection and were helpful and co-operative. Feed back on the inspection findings was given on completion and were received in a constructive and positive way by the deputy manager and representative from Blanchworth Care Group. One requirement has not been complied with since the last inspection. On this occasion the timescale has been extended as indicated in the requirements made. However, unmet requirements impact upon the welfare and safety of residents. Failure to comply by the revised timescale may lead to the CSCI considering enforcement action to secure compliance. What the service does well: We made the following observations both at the thematic inspection and key inspection. Discussion with the staff at the thematic inspection showed high levels of understanding of dementia and how it can affect people. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 6 Staff felt they received good training opportunities, and had done specific training in areas such as Dementia awareness, National Vocational Qualifications in Care Practice, Communication Skills, Abuse and Challenging Behaviour. Lunch was conducted in a manner to support people to get a well-balanced meal, while supporting individuals to eat how they chose. There was lots of verbal interaction, and explanation of what was available, informing people what they were eating for example and individuals were offered alternative choices. People who use the service are supported by well-trained staff, which respect their privacy and dignity, and promote their independence where possible at a level and pace appropriate for people. The home offers people who use the service a varied activities programme based on their needs and choices that also includes trips out. What has improved since the last inspection? What they could do better: The home needs to ensure their care plans for people who use the service reflect their individual needs, are kept up to date and do not contain terminology that can be viewed in both a negative and positive way. The issue with reviewing of care plans was also found at the thematic inspection. Medication systems used must be reviewed to ensure people who use the service are not put at risk. Improvements to the environment are required in relation to safety and infection control procedures. The home also needs to remove unpleasant odours to ensure people live in a comfortable and pleasing home. A number of surveys returned to us by relatives/ friends of people who use the service indicated that there is a concern about communication between the home and them. This area needs to be improved on. More monitoring systems need to be put in place to ensure that any issues are identified and action taken to address them and this will help to ensure the home is run in the best interests of the people who use the service. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 7 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. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have their needs assessed by the home prior to admission to ensure their needs can be met. EVIDENCE: A thematic inspection took place prior to this key inspection and the homes Statement of Purpose was examined in detail. This document was found to provide information about the services offered. The pre admission assessments of two recently admitted people were examined. One of these people was transferred from a sister home. Both people had been assessed by the registered manager prior to moving into the home. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 10 One person was assessed at their own home with a family member present and the other person was assessed at the other care home with a social worker and a family member present. A letter confirming the needs of the person can be met is sent from head office along with the contract. Because of this, we were unable to examine these documents at this inspection. Intermediate care is not provided at Breadstone House. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. However this is not always recorded in their care records and systems used for managing medication must improve to prevent any risks to people. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The care of three people was examined in detail. This includes reading care records, speaking to the person where able about their care and speaking to a member of staff. One person was on respite care, one was recently admitted to the home and the other person had been living at the home for a number of years. All three had care plans in place. The person receiving respite care had care plans that were current; however from discussing the care of this person with the deputy manager it was found that one care plan relating to personal care did not contain information about their preference. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 12 The person transferred from a sister home had care plans that were also not always updated with their present care needs. The person who has been living at the home for a number of years had care plans that did not detail personalised care and were not always updated. The terminology used in one care plan must to be reviewed and removed. A quote from this care plan for sleeping said to “ensure stays awake during the day”. No further details were provided on how this would be achieved and it had not taken into account the choice or views of the person. This is poor practice as this quote could be viewed in a positive or negative way. The deputy manager agreed that the care plans for this person need to be re-written. This person was going to have their care reviewed following a fall the night before this inspection and receiving an injury that required hospital attention. Equipment from the local Primary Care Trust had been obtained by the home to reduce the risks to this person. At the thematic inspection completed prior to this key inspection it was noted that care plans were not being reviewed regularly. Risk assessments were in place for falls, pressure areas, moving and handling, nutrition and mouth care. Written risk assessments were in place for people who required them. One person had a risk assessment completed for mouth care that was first completed in September 2007 and then the review date was planned for March 2008. This is too long to leave a review of an assessment especially as the condition of this person was deteriating. One person’s family had signed a risk assessment. Evidence was seen of health professional visits and this includes GP, chiropodist and community nurses. One visitor/relative to the home had made a comment in their survey that it took ‘5 weeks to obtain the services of a dentist following treatment of a swollen check/gum’. The person who had been living at the home for a number of years is one of several people who use the service that wear hip protectors, however this was not seen in their care records. A question on the survey asked relatives/visitors to the home if they felt the home meets the needs of their relative/friend, eleven had replied’ always’ and eight had replied ‘usually’. Comments include “the needs of my relative are definitely met” and “ I do not consider the home meets their needs continuously as my relative is made to fit into their timetable” Medication systems used by the home were examined. During the first day of the inspection it was noticed that one nurse was observed walking to the medication room on the first floor with three ‘nomad’ boxes of medication in their hand. This is unsafe practice. A risk assessment must be undertaken by the home to determine the safest way to administer medication. The home should refer to the recent publication by the Royal Pharmaceutical Society ‘The Handling of Medicine in Social Care’ for details on safe storage of medication. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 13 The Medication Administration Records (MAR) were examined. Some issues and concerns were noted, • • • • Handwritten entries were not routinely signed by and checked by a second member of staff. Gaps were found in the recording of administration of a number of people. One prescription said that a nutritional drink needs to be given twice a day but was only being given once a day. This must be corrected. On one person’s MAR it was noticed that the evening medication had been signed for despite it being the middle of the day. It was difficult to ascertain what was happening with this medication and it is very important for this person’s treatment that they receive this medication at the times set. An audit check was randomly undertaken on one person’s medication, which was anti-biotics along with their records of administration. It was found that they were due fourteen tablets and twelve had been signed for, however three tablets remained in the box. • This evidence indicates that the medication records are inaccurate and could place people at risk of receiving the wrong levels of medication. This can be a risk to their health and well-being. Allergies and a photograph are included as part of the Medication Administration Records (MAR). Records were seen for medication received in to the home and for any returned. One person who was chosen at random was receiving medication to be given as required and we checked they had a care plan in place for its use. A care plan was in place but did not go into enough detail about how and when it should be used. This is needed to help make sure all nurses understand the correct use of this medication for each person. One medication trolley is stored downstairs and a thermometer is present in the room to check on the temperature, however in the medication room on the first floor no thermometer is provided, therefore the home is not able to demonstrate the medication is stored at a safe temperature below 25°c. The homely remedy policy was last updated in 2005 and it is strongly advised that the home review this with the local GP immediately. As the people who use the service will have changed and to ensure there are no interacts between medications used by the person and the homely remedies. The medication used for homely remedies has not been dated on opening. This is to ensure the medication is still within the manufactures guidance for use. This must be rectified. The home does have a specimen signature list so they are able to know who as administered medication to people who use the service. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 14 A drug reference book is available but was dated September 2006 and consideration should be given to obtaining a more up to date edition. Nurses spoken with said they had undertaken medication training as part of their induction course. Staff were observed treating people who use the service with respect, this included addressing them by their preferred term of address and knocking on their doors prior to entering. At the thematic inspection it was noticed by us “Residents who use the service are supported by well-trained staff, which respect their privacy and dignity, and promote their independence where possible at a level and pace appropriate for the residents”. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are supported to make choices about their daily lives. A range of activities is provided to meet their choices and abilities. EVIDENCE: In the main entrance to the home there is an activities notice board, which includes a programme for the week ahead and photographs and information about activities that have taken place. A member of staff is designated as the activities coordinator and she is very enthusiastic about the role. Activities were taking place during both days of the inspection. Photographs are on display of outing the home has undertaken. For people who are unable to take part in-group activities the coordinator is able to provide one to one time. One relative/visitor to the home had written in their survey “without the activities coordinator it would be a boring and depressing place to live”. In another survey it was mentioned that the television in one of lounges does not work and has not been replaced. Outside entertainers that visit the home include ‘pat the dog’ and music and movement. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 16 Two relatives/visitors to the home had commented in their surveys that the spiritual needs of their relatives were being met and services take place every month. Visiting to the home is not restricted and visitors were seen during the inspection. One relative/visitor said in their survey they would like their relative to go out even though they are not able to mobilise without the help of staff. Staff were observed giving people choices about their daily lives. This includes asking them what they would like to eat and drink and asking if they wish to join in activities. Rooms seen belonging to people who use the service are personalised with their belongings on view. Information about advocacy is on the notice board in the main entrance. Several mealtimes were observed and in one dining room where people are able to assist themselves they are offered serving dishes of accompaniments to the meals. One person did not like what was on offer during one mealtime and an alternative was provided. In the other dining area people require more assistance from staff, which was observed as being given in a sensitive and timely manner. This was also the finding of our thematic inspection. The kitchen was inspected in so far as health and safety check and food records. A letter dated July 2007 from the local Environment Health Department has awarded the kitchen ‘4-stars’. Records were seen of health and safety checks and detailed food records are maintained. The kitchen staff have a list of likes and dislikes of people who use the service as well as any therapeutic diets they are taking. People who require a soft diet have all parts of the meal blended separately for presentation. The home does not offer people who use the service a cooked breakfast as the care staff prepares the breakfasts. Other homes in the Blanchworth Care Group do provide people who with the option of a cooked breakfast and consideration should be given whether it is feasible in this home. People who use the service were asked if they enjoyed their meals and everyone said yes. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service and their relatives/friends have access to a complaints procedure and systems are in place to protect people from abuse. EVIDENCE: The home has a complaints log and the last recorded complaint was received in 2006. A copy of the Blanchworth Care Group complaints procedure is displayed in the home. Relatives/visitors were asked in their surveys if they know how to make a complaint. Fifteen people replied ‘yes’ they know how to make a complaint and three people replied ‘no’ they don’t know how to make a complaint and one person ‘can’t remember’ how to make a complaint. Comments include ‘I would go to the senior staff if I had any complaints’, ‘on the occasions I have had a concern I have gone to the senior staff who have always dealt with my worries’ and ‘I have never been told how to make a complaint though I often feel like making one’. One relative/visitor said in their survey they did complaint to the head office following an incident but feel nothing improved because of it. Blanchworth Care Group provides in house training for staff in relation to abuse and challenging behaviour and this is normally undertaken during the induction training. Policies and procedures are in place and this includes whistle blowing. Staff confirmed they have undertaken training about abuse. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 18 A copy of the policies and procedures are given to staff at the induction training. A copy of the ‘Alerters’ guide was on the notice board in the office on the ground floor. As all the training records for staff were not examined in detail, consideration should be given to the home checking that staff who have received abuse training prior to the changes in the local reporting procedures as updated with this. One person who uses the service was referred to the Adult Protection Agency following an allegation made and an investigation took place by the Police; due to circumstances of this allegation this has now been closed. Two allegations of theft have been made since the last inspection and the Police were informed. Reference numbers were seen as evidence that POVAfirst and Criminal Records Bureau Disclosures (CRB) are undertaken for new staff. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 & 26 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service live in a comfortable environment, however improvements to safety and infection control are essential as these potentially place people at risk. EVIDENCE: A tour of the environment took place with a number of rooms used by people being observed. At the top of the staircase by the main entrance the domestic’s trolley was left unattended with chemicals used for cleaning on it. This is unsafe practice as people who use the service could be put at risk. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 20 Three toilets used by people who use the service did not have locks on them which could compromise people’s privacy and dignity, however the deputy manager said that the vast majority of people who use the service need assistance to use the toilet and the staff ensure their privacy is maintained. Several toilets did have locks so people could use them if they wished. On the first day of the inspection odours were found in one corridor and the next day the carpets were being deep cleaned. On the second day of the inspection an odour was found in one room and this was reported to the deputy manager. No other concerns were noted with the cleanliness of the home except for the odours found. People who use the service are able to spend time in a number of communal rooms and an enclosed patio area can be used during the warmer weather. The home has received funding from the Department of Health to install a 1940’s memory room. As part of the tour of the home on the second day of the inspection pillows and pillowcases were examined in a number of rooms randomly selected. Out of the six rooms inspected, four had pillowcases that were soiled and should have been changed as all beds had been made. And in three rooms the pillows were also heavily stained and must be replaced. This was also highlighted at the last inspection. The laundry is sited away from the home and from discussions with the member of staff who manages the laundry they said there is a procedure in place for managing soiled linen to reduce any risk to the staff. However during the tour of the home it was noticed that in one bathroom soiled sheets had been left on a linen trolley, which did not have a laundry bag on and were not put into the appropriate bag. This is poor practice and places people who use the service at risk of cross infection. The deputy manager was asked how the home disposes of incontinence pads and she said they are placed into a bag and then placed in a black bin liner, this was also observed. This is not in line with the Lists of Waste Regulations 2005 and the European Waste Catalogue Codes and must be rectified. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is confident that they have sufficient numbers of staff to meet the needs of the people who use the service. However some staff require training in moving and handling to ensure people who use the service are not put at unnecessary risk. EVIDENCE: Duty rotas were examined with the deputy manager. The duty rota is checked by the member of staff in charge of the home to ensure the correct staff are on duty. Ancillary staff are available to support the care staff. The deputy manager felt the numbers of staff on duty are able to meet the needs of the people who use the service. Since the last key inspection the home has reported to us they have worked one member of staff below the staffing numbers they set six times. Staff spoken with said they are able to discuss with the management of the home if they feel they need more staff. Staff felt Breadstone House is a nice place to work and that they have a good team spirit. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 22 A number of surveys completed by staff were sent to us prior to the inspection and the comments included, “ we work as a team and as a member of that team I am always trying to improve and help other members of our team to improve what we do” and “ service users are well cared for”. Two comments were about the home needing more staff especially to help with breakfasts and the activities coordinator does not help with personal care. One person who uses the service said the staff are all very good. At the thematic inspection, which took place prior to this key inspection, we found the staff showed high levels of understanding of dementia and how it can affect people. Relatives/visitors to the home were asked in their survey if they felt the staff in the home had the right skills and experience to look after people properly, seven people has replied ‘always’, ten replied ‘usually’, one replied ‘sometimes’ and two people did not answer the question. The homes Annual Quality Assurance Assessment (AQAA) states that currently 64 of care staff have NVQ 2 or above and an additional 64 are currently undertaking this training. These numbers exceed the standard. The personnel records for two recently appointed staff were examined on Blanchworth Care computer system. Evidence was seen of all the required checks, however one person had not worked for five months prior to starting at the home and no records were maintained of what they were doing during this time. To ensure they have a robust recruitment procedure consideration should be given to documenting what they were doing during this period. Blanchworth Care uses Skills for Care common induction standards for care staff. Qualified nurses have another induction booklet to follow. Records were seen of one new qualified nurse following the induction programme. Staff spoken with confirmed they undertake a 3-day induction with an extra half day for qualified nurse, which covers medication. The training matrix was examined and it identifies when staff have last had training in certain areas and when it is due again. It was found that at least two members of staff have not had moving and handling practical sessions in the case of one member of staff since November 2004. The home has plans to address this shortly as this could potentially place people who use the service at risk. The thematic inspection undertaken by us prior to this inspection found that staff felt they received good training opportunities, and had done specific training in areas such as Dementia awareness, National Vocational Qualifications in Care Practice, Communication Skills, Abuse and Challenging Behaviour. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A competent person supervises the management and administration of the home, and a quality assurance system is in place. However this needs to be improved with monitoring systems to ensure the home is run in the best interests of the people who use the service. EVIDENCE: The Registered Manager was not at the home during the inspection as she was on annual leave, however the deputy manager was available. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 24 During this inspection we were told that the Registered Manager has tendered her resignation and this was followed up in writing a couple of days after the inspection. Staff spoken with felt the management team were approachable and they could discuss any concerns they have with them and they have staff meeting on a frequent basis. Several relatives/visitors raised some concerns in their survey about the fact at some weekends the Registered Manager or deputy manager are not on duty and that communication between the home and relatives is not very good. This needs to be addressed. A copy of the results of the home quality assurance survey that took place in June this year is displayed on the notice board. The deputy manager said that questionnaires are sent out to relatives and other stakeholders due to the medical condition of the people who use the service. The deputy manager said that if any issues were identified on these surveys an action plan would be devised. Regulation 26 visits take place and records were seen of these. From the evidence seen during the inspection the Registered Manager only appears to audit accidents on a monthly basis. As part of the Regulation 26 audits of accidents were seen for April this year, medication was done in February this year and care plans in January this year. If more monitoring systems are used in the home then some of the issues identified in this report could have been picked up by the home and corrected. The home is able to store monies for people who use the service in a secure facility. Records were seen of any transactions and receipts are kept. Two members of staff sign in and out any monies for safety and evidence was seen of the home checking the totals. Records were seen relating to staff supervision that is carried out by the Registered Manager. The nurse in charge on nights carries out the supervision of night staff. The deputy manager said the Registered Manager and nurse in charge on nights have undertaken training to be able to undertake supervision sessions. Both the supervisor and member of staff sign the form at the end of each session. The deputy manager said appraisals take place on a yearly basis. A randomly selected number of records were seen of staff supervision. Staff spoken with confirmed they receive supervision sessions, however one staff survey had a comment on there that they do not meet regularly with the Registered Manager and say to ask the Registered Manager why. The homes AQAA lists dates of servicing for electrical equipment and circuits and heating systems. Maintenance records in the home contain details of checks that are undertaken on weekly, monthly and half yearly checks etc. Fire equipment is checked on weekly basis for alarms, doors and escape routes and monthly for emergency lights. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 25 A fire company has checked fire equipment. Training records were seen of fire drills involving staff. Water temperatures and wheelchairs are checked on a monthly basis. No fire risk assessment was seen at this inspection and from information obtained at another Blanchworth Care home they are still in the process of being written. Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X 1 X 1 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP7 OP7 Regulation 15 (2) b 15(1) Requirement Care plans for residents must be reviewed regularly. Timescale for action 25/11/07 31/12/07 Care plans must be devised for people who use the service based on their individual assessed needs. This is to ensure their health and well-being are being met. When medication is administered to people who live in the home it must be clearly and accurately recorded and given in accordance with the doctor’s directions. There must be up to date medicine care plans to clearly describe how to use any medicines prescribed to use ‘as required’ or ‘as directed’. This will help to make sure people receive the correct levels of medication. All medicines must be kept securely at all times so as not to present any risk to anybody in the home. This relates to having a method to safely transport medicines around the home. DS0000063838.V348272.R01.S.doc 3. OP9 13(2) 10/12/07 4. OP9 13(2) 10/12/07 Breadstone House Care Centre Version 5.2 Page 28 5. OP9 13(2) 6. OP19 13(4c) 7. OP24 16 (2) (c) & (e) 8. OP26 16(2K) 9. OP26 13(3) 10. OP26 16(k) 11. OP30 18 1(ci) The home must demonstrate that the medications stored in the upstairs room are stored at a safe temperature below 25°c. This is to ensure people who use the service receive their medication safely. Domestic cleaning trolleys that are left unattended with cleaning chemicals present place people who use the service at risk and must be stored in a secure place or with a member of staff. The registered person must ensure that the cleanliness and condition of all pillows, pillowcases and bedclothes in use in the home is reviewed and any remedial action taken. This requirement is outstanding from the last inspection. The home must make suitable arrangements for the appropriate disposal of clinical waste (this is with relation to the Lists of Waste Regulations 2005 and the European Waste Catalogue Codes). Staff in the home must ensure soiled linen is managed in a safe way to ensure that people who use the service are not put at risk of cross infection due to their actions. Odours in the home need to be eliminated to ensure people who use the service live in a pleasing and pleasant environment. All staff must receive training in moving and handling practical to ensure they move people who use the service correctly and in line with the latest legislation. 10/12/07 23/10/07 31/12/07 30/11/07 23/10/07 23/10/07 31/12/07 Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP9 Good Practice Recommendations Residents day and night profiles to be reviewed and updated. Write the date on all containers of medicines when they are first opened to use to help with good stock rotation in accordance with the manufacturers’ or good practice directions and to help with audit checks The home should obtain an up to date drug reference book. Handwritten entries on medicine charts should be signed and dated by the member of staff writing this with a second member of staff checking and signing as correct. The staff in the home should consider attending the Protection Of Vulnerable Adults training provided by Gloucestershire County Council. The risk assessments relating to the use of specialise equipment be linked to polices and procedures in place. This remains outstanding from the thematic inspection. The home should look at using more monitoring systems to help with their quality assurance. 3. 4. 5. 6. OP9 OP9 OP18 OP22 7. OP30 Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Breadstone House Care Centre DS0000063838.V348272.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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