CARE HOMES FOR OLDER PEOPLE
Bredon View 24-26 Libertus Road Cheltenham Gloucestershire GL51 7EL
Lead Inspector Ruth Wilcox Unannounced 25th April 2005 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 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. Bredon View Version 1.10 Page 3 SERVICE INFORMATION
Name of service Bredon View Address 24-26 Libertus Road Cheltenham Gloucestershire GL51 7EL 01242 525087 01242 525087 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) CTCH Ltd To be appointed Care Home 26 Category(ies) of Old Age (26) registration, with number of places Bredon View Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6 December 2004 Brief Description of the Service: Bredon View is a care home converted from two semi-detached older properties. It provides personal care for 26 older people, and is located in a residential area of Cheltenham, close to the railway station and local bus routes. It is part of the CTCH Ltd group of homes. Accommodation is on two floors, the first floor being accessed by a shaft lift and stair lift. All bedrooms have en-suite facilities; some have the addition of a bath or shower. The communal area consists of 2 lounges, dining room and a conservatory at the front of the property. There is a level access to the landscaped gardens at the rear of the home via a patio door from the lounges. Care staff are on duty 24 hours each day, and there are waking night staff. If nursing services are required, these are accessed from the community, and service users can register with the local General Practitioner of their choice. Bredon View Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 5 hours, on one day in April. The home Manager was present throughout the inspection, and the Group Care Manager from CTCH Ltd was also present for part of it. Informal interviews were held with three other staff members, a visiting Community Nurse and hairdresser, and eleven of the eighteen service users in residence were spoken to directly to gain their views of the service and care they receive. The home’s progress towards making improvements that were required at the last inspection was assessed. Care records and the management of medications were inspected, as were the arrangements for social activities and meals. The care of three service users in particular was looked at closely. A tour of the premises took place, and staff were observed going about their daily work, interacting with the service users. Systems for rostering and recruiting staff were inspected. What the service does well:
Bredon View provides well decorated and safely maintained surroundings for the service users living there. The home has a homely atmosphere, and service users are able to personalise their rooms according to their wishes. A good amount of information is available about the home, which will help any interested parties to make their mind up about it before choosing to live there. The home provides a good standard of home cooked food, with a varied and balanced diet. The management of the home has shown that it will not tolerate any abusive behaviour from staff, and has had occasion to dismiss one member of staff last year, with a subsequent referral to the Protection of Vulnerable Adults list of unfit workers. Bredon View Version 1.10 Page 6 What has improved since the last inspection? What they could do better:
Although staff receive a structured induction training when they start work at the home, there were some newer staff that had not received any significant Abuse training to enable them to recognise any signs, and the procedure to follow if they had any concerns; the home must make sure that this most important training is given as soon as possible. Also the new home Manager is aware that some of the new staff are calling service users by affectionate names such as ‘darling’ and ‘love’, and that some may feel this is inappropriate and disrespectful. The standard and choice of the food is good as reported above, however the habit of mashing all the food items into one pile on the plate for those service users needing feeding must not be allowed to continue. Bredon View Version 1.10 Page 7 The home has thorough recruitment procedures for new staff, however if these procedures are not followed properly, with all of the required pre-employment checks completed, then this could potentially place service users at risk. The home must make sure that all of the required checks are fully completed before allowing new people to work with vulnerable service users in the home. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bredon View Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Bredon View Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 5. Service users have access to a good amount of detailed and useful information about the home, which enables them to make a choice about it. The home’s admission procedure ensures that service users are enabled to visit the home and stay on a trial basis before making their final choice about staying there. EVIDENCE: The home has a written Statement of Purpose and Service User Guide, both of which are available in the home; each service user is issued with their own copy of a Service User Guide. Further to some recent staff changes in the home, and in order to reflect the exact numbers of service users accommodated, the Group Care Manager confirmed that amendments to these documents would be notified to the Commission for Social Care Inspection as is required. Bredon View Version 1.10 Page 10 Prospective service users receive a visit from a representative of the home before going in, are able to visit the home before admission, and can stay for the day, or have a meal if they wish; they are able to stay in the home on a trial basis, the time of which can be made flexible according to their needs and wishes. The home does not have a policy of accepting emergency admissions, unless a full assessment can be performed in advance. Bredon View Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10. There is now a clear care planning system in place, which adequately provides staff with the information they need to satisfactorily meet service users’ needs. The systems for the management and administration of medications are good, with clear and comprehensive arrangements in place to ensure that service users’ medication needs are met, though isolated shortfalls in staff practice to employ these consistently may compromise the safety of it. Care and support is offered in such a way as to promote the privacy and dignity of the individual, though some forms of address used to service users could be construed as disrespectful by some. EVIDENCE: Each service users’ care plan was available for inspection, and three were chosen at random to form a case tracking exercise. Bredon View Version 1.10 Page 12 There has been a concerted effort to improve the standard of care plan documentation in the home since the last inspection, and a great deal has been achieved in this regard. The home has done well to remedy the previous serious concerns that had been identified regarding care planning. Care plans were clearly linked to an assessment, had been done in consultation with the service users, and had been regularly reviewed. In the main, documentation was well written and demonstrated how service users’ health and social needs were to be met. Risk assessments were documented for manual handling, pressure sore vulnerability and falls. Case tracking confirmed that appropriate support equipment to meet needs had been sought and provided from community resources. The Community Nurse was present during the morning, and spoke positively about the manner in which the home addresses service users’ health needs. The system for handling service users’ medications is generally safe and well managed. Medications are stored appropriately, with clearly printed Medication Administration Records from the supplying pharmacist. These records are reasonably well maintained by the staff, though there are isolated shortfalls requiring closer attention. These include the following: • Clear instructions must be recorded for the use of external medications • The person responsible must sign all administrations of medicines on the chart. Service users are supported to self-medicate if they wish and are able to, and this is done on the basis of a documented risk assessment. Staff receive accredited medication training from a local college, and there are a number currently undertaking this training at the present time. Staff were very attentive to the service users, and demonstrated a respectful but friendly approach to them. However, the overly familiar use of the term ‘darling’ and ‘love’ by one or two members of staff when addressing service users could be construed as disrespectful, and should be discouraged. Service users spoke very positively about the care that they receive and the manner in which it is delivered. One said ‘this is a dear little place, and I get everything I need from the staff’. Others said that the staff were very good to them, and that they were very kind. The Community Nurse and the hairdresser both said that in their experience and from their observations, arrangements to respect and meet the needs of the service users had improved in the home recently. Bredon View Version 1.10 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 15. A renewed focus on the provision of social activities for service users has ensured that social opportunities for them have been increased and improved. Dietary needs of service users are well catered for, with a balanced and varied selection of food available that meets service users’ tastes and choices; however, more consideration must be given to those requiring help with feeding, in order that their meal is presented in an acceptable manner. EVIDENCE: Since the last inspection there has been an increased focus on the provision of social opportunities for the service users. A monthly diary of activities is produced, which is issued to each person. The current diary and the last two showed a range of social opportunities available from entertainments to craft type activity, to religious and special calendar and festival dates, to games and screening of major sporting events. The Acting Manager intends to focus even further in this area soon, but has done well to achieve a programme at this stage since her appointment. Bredon View Version 1.10 Page 14 Menus show a range of varied and nutritious meals available for service users, and observation of the lunch confirmed that they are also offered choice with their meals. The meal looked wholesome and appetising, and service users confirmed their enjoyment of it; service users generally spoke positively about the quality and quantity of food provided for them, with only one person saying that although the food was good, it was sometimes not cooked to her liking, with some vegetables too soft. Most said that the food was good, and that ‘they were well fed’. The dining room was pleasantly laid for the meal, with a glass of sherry available where wanted. Staff were in attendance serving and providing assistance with the meal. One carer seen feeding two particular service users was mashing the different food items into one pile on the plate before feeding it; this practice is considered to be inappropriate and must not be permitted to happen. Bredon View Version 1.10 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18. A clear complaints policy ensures that service users’ complaints or concerns are listened to and addressed. Policies and staff training are provided to protect service users from abuse, though more timely formal training for new staff must be ensured. EVIDENCE: The home has a clearly written and accessible procedure for dealing with complaints. There were no records to inspect on this occasion, though the Acting Manager is aware of the requirement to maintain such records, and has devised her own system for recording and action planning for any concerns raised. The home has written policies and procedures for dealing with abuse, and staff receive training in recognising and dealing with abuse issues. However, two new staff who were receiving structured induction training, were not familiar with the term ‘Whistleblowing’, though one of these demonstrated some awareness of the issues, and said that she had received some instruction inhouse, though this appeared to have been minimal to date. A more experienced staff member was more aware of the issues. Appropriate steps have been taken in response to inappropriate practices by one member of staff, with a dismissal and referral to POVA in the past year.
Bredon View Version 1.10 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24, & 25 . Service users live in pleasant and comfortable surroundings, and recent investment has improved the safety of the home for them. Service users are able to personalise their rooms, by having their own possessions around them. EVIDENCE: A maintenance and redecoration programme is ongoing in the home, but generally the environment is furnished and decorated to a very good standard. Many rooms have been completely refurbished, and this too is to a high standard. All areas are safe, though a back staircase is steep and narrow and could potentially prove dangerous. The home considers this a low risk to service users as it is not used by them. However, due to its close proximity to some
Bredon View Version 1.10 Page 17 service users’ rooms, the Acting Manager is planning to install a gate at the top as a risk reducing measure. Service users’ rooms are well furnished and are comfortable. They are free to introduce personal items, including their own items of furniture where practicable. Each service user is provided with a lockable drawer for their personal use, and though not all have a lock on their door, can have one if they wish. Work to make hot radiators safer has been completed, and the Proprietor is to be commended for the efficient way in which this work has been completed since required by the Commission for Social Care Inspection, and for the aesthetically high standard to which it has been done. It has been confirmed that hot water temperatures are made safe by blending valves; random monitoring looks for any anomalies. Isolated hand checks during this inspection raised slight concerns about some of the temperatures, and the Acting Manager resolved to have this checked. Bredon View Version 1.10 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29. After a period of instability and change there are clear signs that a cohesive team of staff is being established, in order to provide greater consistency for the service users, though this has yet to be fully consolidated. The procedures for recruiting staff are robust, but failure to follow these procedures thoroughly could potentially place service users at risk. EVIDENCE: Records of all staffing provided are maintained in a staff rota. Staffing has been problematic in the home in recent months, with a significant turnover of people. Although this has the adverse effect of giving inconsistency and lack of continuity for service users, the changes have also been viewed in a positive way. In order to establish an appropriate skill mix of staff, who can evolve into a cohesive team, it has been necessary to have some change, and the opportunity to achieve this is being taken full advantage of by the Acting Manager. During this difficult time and process, there is an additional carer regularly on duty, and on the day of this inspection, four care staff plus the Acting Manager were on duty for the eighteen service users in residence. Two cleaning staff were also on duty. The Cook was absent due to ill health, and the Acting Manager was cooking the breakfast and lunch.
Bredon View Version 1.10 Page 19 Staff were observed during the day, and were evidently meeting the needs of the service users in an efficient and timely way, with much better direction and supervision from the new Manager in post being given. Service users themselves indicated that staff were kind, and that they were getting everything they needed from them. Regular visitors to the home said that the staff team was getting much better under the clearer direction that now exists. Five examples of staff records were inspected, which were of staff recently recruited to the home. Evidence of the required pre-employment checks was seen throughout, with shortfalls identified in recruitment practice for two people. A full employment history with a written explanation of reasons for gaps had not been obtained, and a written verification of the reason why the person had ceased to work in their last position, as it had involved working with vulnerable adults, had also not been obtained. These statutory requirements were issued at the last inspection, and compliance has evidently not been ensured within the timescale. In the case of the second person, one of the written references seemed to post date the person’s employment start date, and had not been signed by the referee; this means that the authenticity of the reference could be drawn into question, and that the Care Home Regulation requiring the home to obtain two written references before a person commences employment had not been fully observed. Two of the files did not contain a photograph of the person, though past information confirms that photographs of each worker is held in the Company head office. Evidence that Criminal Records Bureau disclosures had been received was obtained, though none were seen directly on this occasion, and will be followed up at the Company head office. Bredon View Version 1.10 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32 & 36. The recent changes to the management arrangements in the home have produced a more consistent and positive approach to the benefit of all living and working in the home. EVIDENCE: A new Manager has been appointed to the home since the last inspection, who has come from another home within the CTCH Ltd group; she has yet to be registered with the Commission for Social Care Inspection, and is referred to as ‘Acting’ for the purposes of this report. She has the qualifications and experience necessary for managing the home, and is already providing some clear direction and leadership for the staff team. Each member of staff has received a formal supervision session, which has been recorded; the number of sessions will be increased overtime, now that the new Manager is in post. Bredon View Version 1.10 Page 21 Staff are evidently benefiting from the new management arrangements, and indicate that they feel valued, and are able to participate in decisions in the home. The new manager is viewed as being approachable by all, and as having a very positive influence in the home as a whole, including the lives of the service users. Service users are consulted and are afforded a voice on an individual basis, though a more formal forum has not taken place; the Acting Manager intends to introduce service user meetings as soon as possible. Bredon View Version 1.10 Page 22 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 2
COMPLAINTS AND PROTECTION 3 x x x x 3 3 x STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 x x x 3 x x Bredon View Version 1.10 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2) Requirement Clear instructions for the use of external medications must be printed on the Medication Administration Charts. Staff must ensure that they sign medication charts consistently, for every drug administered. All meals must be served in an appropriate manner, which fully takes into account the needs of the service user. The home must ensure that new staff receive appropriate and timely Adult Protection training when they start work. When recruiting new staff, the home must obtain written verification of the reason why the person ceased to work in their last position (if it involved contact with vulnerable adults or children. (previous timescale of 31 January 2005 not met) When recruiting new staff, the home must obtain a full employment history with satisfactory written explanation of reasons for gaps in employment. (previous timescale of 31
Version 1.10 Timescale for action 31 May 2005 31 May 2005 31 May 2005 31 May 2005 31 May 2005 2. 3. 9 15 17(1.a) Schedule 3. 16 (2.i) 4. 18 13(6) 5. 29 19 6. 29 19(1.b.i) Schedule 2. 31 May 2005 Bredon View Page 24 January 2005 not met) 7. 29 19 (1.b.i) Schedule 2. When recruiting new staff, the home must obtain two written references, and be satisfied as to the authenticity of them before employment commences. 31 May 2005 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 10 36 Good Practice Recommendations Staff should be discouraged from using such forms of address as Darling and Love when talking to service users. Staff should receive at least six formal supervision sessions each year. Bredon View Version 1.10 Page 25 Commission for Social Care Inspection Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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