Inspection on 15/02/06 for Buckland Court

This inspection was carried out on 15th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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

Buckland Court 05/11/08

Buckland Court 15/11/06

Buckland Court 23/08/05

Buckland Court 21/02/05

Buckland Court 04/11/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Buckland Court Southmill Road Amesbury Salisbury Wiltshire SP4 7HR Lead Inspector Ms Sally Walker Unannounced Inspection 15th February 2006 09:25 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 Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 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. Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Buckland Court Address Southmill Road Amesbury Salisbury Wiltshire SP4 7HR 01980 623506 01980 626638 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) The Orders Of St John Care Trust Mrs Julie Watts Care Home 50 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (50) of places Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users who may be accommodated in the home at any one time is 50 No more than 18 service users aged 65 years and over with dementia may be accommodated in the home at any one time 23rd August 2005 Date of last inspection Brief Description of the Service: Buckland Court is a single storey care home purpose built by the local authority nearly 30 years ago. It is registered to The Orders of St John Care Trust to provide care for a total of 50 older people, 18 of whom may have a dementia. All accommodation is in single rooms with wash hand basins, most rooms being somewhat smaller than standard. There is one room for respite care and a separate day care facility for up to 20 older people. The Orders of St John Care Trust were registered in 1999. The staffing rota provided for a care leader and 4 care staff during the morning, a care leader and 3 care staff during the afternoon and evening and 3 waking night staff. There were 3 housekeepers, a chef and a kitchen assistant. Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9.25am and 5.25pm. Four residents and three staff were spoken with. Mrs Julie Watts, manager, was present during the inspection. The care records and fire logbook were inspected. A tour of the building was made. What the service does well: What has improved since the last inspection? Care plans were much improved and showed a better picture of residents care needs and how they were being met and monitored. Systems are now in place to show that the home is complying with the Conditions of Registration with regard to the number of beds registered for dementia. Pre-admission assessments had improved with a better range and quality of information being sought. A programme of training is in place for working with people with dementia. Work had been done to safeguard an exposed radiator in one of the bathrooms. Another bathroom which had been out of use for some time was due to be fitted with a specialist bath. The appointment of an activities coordinator had improved the range and quality of activities. A fire door has a security device approved by the Fire Authority to stop residents going from the building unassisted. The door still opens in an emergency. Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 7 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 Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 8 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 the following standard(s): 3&4 All prospective residents will be assessed by the home to make sure their needs can be met. Mrs Watts has made sure that systems are in place so that the Conditions of Registration are complied with. EVIDENCE: The requirement that the home must comply with the Conditions of Registration with regard to the number of residents in each Category had been actioned. Mrs Watts confirmed that she had completed the organisation’s dependency assessment for each resident and colour codes now identified each resident in the category of dementia on a notice board. She went on to say that this was a clear guide to staff when referrals were made. Mrs Watts said she had written to the GPs of those residents in this category for written confirmation of a diagnosis of dementia. Mrs Watts said she was considering a variation in category to include mental health, particularly for the respite provision. Discussions were held about the process which should include confirmation that staffing levels and a programme of staff training in mental health would support this variation. Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 9 Pre-admission assessments were in place for recently admitted residents. These assessments gave a social history and gained information from the residents as well as their care manager, family or previous placement. One permanent resident said they knew about the home as they had attended the day service and made use of the respite service. One relative said the home had a good reputation locally. The residents and their relative said their admission to the home had been a positive experience. Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 7, 8, 9 & 10 Care planning had improved. Residents had good access to healthcare professionals. Tissue viability risk assessments were poor. Residents who administered their own medication said they always had fresh supplies. Staff value residents’ need for respect and privacy. EVIDENCE: All residents had a care plan which showed regular review and revision. Care plans covered all aspects of residents’ needs including preferred routines for giving of personal care and medication, healthcare needs and interventions, risk assessment, eating and drinking, behaviours and infections. The recording had generally improved. The requirement that each resident was assessed as to their risk of developing pressure damage and that training and advice was sought from the tissue viability nurse had been actioned in part. Mrs Watts said she had received training in tissue viability. The organisation had confirmed to the Commission that a recognised tool would be used in its homes. A statement in the risk assessment file identified that some residents were at risk but it was not possible to establish which elements had been considered or how the decision was quantified. There were statements in some of the care plans that the district nurse should be alerted if red marks appeared, clearly too late to take preventative action. The inspector was of the opinion that the pressure area risk assessments and care plans showed Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 11 that staff did not have an understanding of good pressure area care or that any training undertaken was not understood. Pressure relieving equipment was in place. The records showed that any concerns were promptly referred to the relevant specialist. The recommendation that the use of body maps would help with the recording of wounds was implemented in some instances. The recommendation that the daily statements in residents’ records should be reviewed to ensure that they were clear and detailed had been actioned. Recording was much improved with a generally better picture of how the care was provided with reports of progress and monitoring. However there were some entries which were not clear, for example, ‘dressing to right leg’ and ‘sore on back’. A full inspection of the administration and control of medication was not carried out. However residents were asked about their medication and many could administer their own medication following a risk assessment. Other residents said that staff gave them their medication at the times for which it was prescribed. Residents said they could have pain relief if needed. One resident who used an inhaler said that staff kept a stock so they never ran out. It was clear from talking to residents that staff were very considerate of residents needs of respect and privacy. Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 12 & 15 The range of activities has improved since an activities co-ordinator has been employed. Residents enjoyed the quality and range of meals provided. EVIDENCE: A number of the residents described the Valentines Day celebrations that were held the previous day. The dining room had been decorated, all the residents had been given a rose and a card and the food provided at teatime had been heart shaped. The home employs a part time activities co-ordinator. One resident said they enjoyed knitting. Another resident said they had been taken out to lunch by a member of staff which they enjoyed very much. Mrs Watts said she had met with residents to suggest providing holidays but none of the current residents were interested. A number of the residents said they enjoyed having their breakfast in their bedrooms so they could get up in their own time. One resident who had a particular interest in food, described the meals, snacks and drinks provided throughout the day. They said they enjoyed the meals and described cooked breakfasts, snacks at suppertime and during the night if needed. Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 16 & 18 A complaints procedure was in place for residents and their representative to complain about the service. The local vulnerable adults procedure was in place. EVIDENCE: The complaints procedure was displayed in the main entrance with forms to record details. Residents appeared to be confident in reporting any issues to their keyworker or Mrs Watts. Copies of the local vulnerable procedure was available in the main entrance. Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 19 & 26 Residents enjoy a comfortable, warm, clean and reasonably well-maintained environment. Some areas are neglected, notably bedroom doors with groove marks taking off the paint. EVIDENCE: A new call bell system had been installed. The requirement that the hot water flow to the heated towel rail in one of the bathrooms was either restored and the radiator guarded or removed and replaced with a guaranteed how surface temperature radiator had been actioned. The hot water flow was restored and the radiator guarded. The requirement that explicit times that residents can be left without staff when choosing to bath alone must be identified in their care plans and risk assessments had been actioned. All residents risk assessments had been reviewed and updated to include whether they could bath alone, times were recorded and some assessments identified that residents were never left alone. The requirement that an action plan with timescales must be submitted for the replacement of the stained carpet in the corridor near the dining room had Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 15 been action. Mrs Watts in her action plan said that the carpet would be professionally cleaned, deep cleaned each week by housekeeping staff and if no improvement it would be replaced in the next years budget. Staff were cleaning the carpet that morning. There has been some improvement in this area. However the carpet which continues into the dining room was particularly stained and marked by the serveries. The requirement remains for an action plan for the replacement of this carpet. The requirement that the safety was ensured of those residents who were deemed not able to exit the home unsupervised had been resolved and action taken. The requirement included obtaining specialist adaptations to the fire exit doors in consultation with the Fire Authority. Mrs Watts said that the particular resident who was exiting the doors had moved. She showed the inspector the approved adaptation to the door to enable the fire door to only be opened either if the fire alarm was activated or by the break glass unit in an emergency. There are some areas of the home, identified in the past, that are in need of urgent repair, notably bedroom doors with groove marks probably cause by wheelchairs or trolleys. These are in contrast to other parts of the home which have benefited from redecoration and refurbishment. The home must provide an action plan with timescales for when outstanding repairs and refurbishments will be completed. The member of staff with delegated responsibility for fire prevention showed the inspector the tests, checks, instruction and maintenance log. The home had to ‘fire marshals’ to comply with new fire legislation due in April 2006. The log was being satisfactorily completed. There was clear guidance to staff on managing infections and this was available to housekeeping staff. The latest Health Protection Agency guidance to care homes on infection control was emailed to the home. Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30 Staffing levels have not increased as per the organisation’s proposal. Staff recruitment procedures do not protect residents. Staff are inducted and trained to carry out their work. Staff had good relationships with residents. EVIDENCE: The requirement that staffing levels were sufficient to meet the needs of residents as defined in the organisation’s own staffing proposals dated 24th may 2005 had not been actioned. Mrs Watts reported that the organisation had provided the home with a 20 hour care support post which was in process of recruitment. Mrs Watts was hoping to vire 20 hours from the housekeeping allocation to recruit another care support worker. The care support role does not include intimate personal care but will enable care staff to relinquish some bed making and other domestic duties to concentrate on caring. The care staffing rota still only provides for 5 care staff and a care leader during weekday mornings, four care staff and a care leader for the afternoons and evenings during the week and 2 waking night staff. The staffing levels were reduced at the weekend to 4 care staff and care leader during the mornings and 3 care staff and a care leader for the afternoons and evenings. With the care leader having to run the shift, deal with enquires, administer medication and carry out their delegated administrative duties, there are times when only 3 care staff are working with 50 residents, 18 of whom may have a dementia. The residents accommodation is spread over a wide area. A number of residents said that staff did not have time to sit and talk. One resident said the staff were always very busy. Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 17 Mrs Watts reported that 2 staff were undertaking training in dementia provided by the organisation. The course, endorsed by the Alzheimers Society, involved a work book and exam. Mrs Watts had put together a resource file on dementia and was collating material for information about Parkinson’s disease. Residents said that the staff were very kind. One resident said that staff never grumbled and that it was a happy place. Residents confirmed that they had the same member of staff to bath them each week. Many of the residents said that they had good relationships with their keyworkers. One female resident said that they did not object to receiving personal care from one of the male staff and this choice was identified on all the care plans. The organisation had provided the home with staff from overseas, recruited via an agency. Mrs Watts was asked about the process of their recruitment and provided staffing records. The inspector was concerned that Mrs Watts had had no input into the recruitment process although records showed that she had inducted the new staff, ensured that the rota provided for them to be shadowed during their induction, obtained POVA clearance before they commenced work and a Criminal Records Bureau certificate. The records provided by the organisation were incomplete. Application forms were not signed and details of interview records were sparse or illegible. One staff did not have translations of the documents so it could not be established whether a Criminal Records Bureau equivalent check had been carried in their own country, whether the references or certificates of qualifications were valid. One staff had worked on a summer placement in this country but no references were obtained. One staff had worked at another home in the organisation but had not filled out an application form for this post. Mrs Watts said it was an internal transfer. Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 36, 37 & 38 Staff are appropriately supervised. Recording systems have improved. Poor moving and handling practice was observed although Mrs Watts immediately addressed the issue during the inspection. EVIDENCE: Staff files showed staff have regular professional supervision. The requirement that if useful recording systems were removed from files, that they were replaced with a more suitable system or a rationale given for their removal had been actioned. The long term care plan/assessment documents had been reinstated into residents files. The documents with regard to residents risk of developing pressure damage had not been reinstated. Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 19 The inspector made 2 separate observations of poor manual handling which put the residents at risk of possible dislocation of their shoulders. One of the staff said they had received the training and the other who was newly appointed had not but was due to attend a course the following week. Mrs Watts during the inspection arranged for both members of staff to receive immediate training in moving and handling. Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 20 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 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 3 3 2 Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 21 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 OP8 Regulation 13(4)(c) Requirement Timescale for action 31/03/06 2. OP21 23(2)(j) 3. OP27 18(1)(a) 4. OP37 17 The person registered must ensure that each resident has a written assessment with regard to their risk of developing pressure sores. (This part of the requirement not actioned) Training and advice must be sought regarding Tissue Viability. The person registered must 30/04/06 ensure that the bathroom identified is not used for storage and is available for the residents use. (The bath had been removed pending installation of a specialist bath). The person registered must 15/02/06 ensure that staffing levels are sufficient to meet the needs of residents as defined in the organisations own staffing proposal dated 24th May 2005. (The organisation had provided just 20 hours care support hours which was being recruited). The person registered must 31/03/06 ensure that if useful recording systems are removed from files, that they are replaced by a more suitable system or a rationale is DS0000028269.V278743.R01.S.doc Version 5.1 Buckland Court Page 22 5. OP19 6 OP19 7. OP29 given for their removal. (Actioned in part at 15.2.06) 16(2)(c) & The person registered must 30/04/06 23(2)(d) submit an action plan with timescales for the replacement of the stained carpet in the corridor near the dining room. (Attempts had been made to clean the carpet each week. The carpet remained stained). 23(2)(b) The person registered must 31/03/06 submit an action plan to the Commission with timescales for the completion of refurbishment to those areas of the home in need of redecoration. 19 & The person registered must 15/02/06 Schedule ensure that they are involved in 2 the recruitment process of staff from overseas to make sure that they meet the requirement of Regulation 19 and that all the documents in Schedule 2 are available for the protection of the residents. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 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 Buckland Court DS0000028269.V278743.R01.S.doc Version 5.1 Page 24 - 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!