Inspection on 15/11/06 for Buckland Court

This inspection was carried out on 15th November 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Buckland Court 05/11/08

Buckland Court 15/02/06

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 09:15 15 November 2006 th 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.V311152.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. Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 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.V311152.R01.S.doc Version 5.2 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 15th February 2006 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. Mrs Julie Watts is the registered manager. 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. At night there are 3 waking night staff. There were 3 housekeepers, a chef and a kitchen assistant. The fees for the home were between £370.57 and £486.39. The fee did not cover newspapers, chiropody, hair dressing, toiletries or clothing. Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 2 days as the manager was on leave on the first day; 15th November 2006 9.15am to 4.40pm and 20th November 2006 9.30am to 5.35pm. Donna Neary and Dawn Bone, care leaders assisted the inspector with access to records and information on the first day. Five residents were spoken with in detail. A tour of the building was made. The care records, staffing records, medication arrangements and activities records were inspected. As part of the inspection process the views of some residents’ families, care managers and GPs were sought. One of the GPs said the care was fantastic, staff have the best interests of the service users, they are treated as if its their own home. No concerns, staff are very good.” Another GP said that they had never had any doubts as to the quality of care provided. They went on to say that they felt the residents were always well looked after and they were pleased to say that they had never had any cause to be concerned. Another GP said they were fine with the care that their patient received. One of the residents’ relatives said the resident was very happy at the home. They said the staff were very good and they had no complaints. One of the community nurses said that the home was very good and that the manager and staff had a good attitude to the residents. They said that the staff were very skilled in what they did and had a good understanding of the needs of people with dementia. They went on to say that Buckland Court was very homely and client centered. Staff were open to advice and quick to alert any concerns. They also said very positive comments about the day service. They said their only concern was that The Orders of St John Care Trust appeared to keep moving their managers around the homes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Care staff ensure that residents are provided with a good quality of physical care. Residents’ healthcare needs were being met and residents had good access to the GP and district nurses. All residents were well groomed. They had access to their call bell systems if they were in their bedrooms and a good Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 6 supply of fresh juice. As a matter of good practice staff were documenting how they were monitoring residents food and fluid intake and diet. Care plans detailed how individual care was to be provided taking into consideration the residents own preferred routines. Residents were not expected to walk the long distance in some cases, from their bedrooms to the communal areas; they were offered wheelchairs. The arrangements for the administration and control of medication were being well maintained. There were robust procedures in place to ensure that staff were continually competent to administer medication. Residents could administer their own medication following a risk assessment. Most medication prescribed to be administered ‘when required’ was detailed in residents care plans. The activities co-ordinator provided a good range of group and individual activities both in the locality and at the home. The cook provided special menus for celebration of calendar events and many of the residents remarked on their enjoyment of the efforts made. The cooks provided a high standard of fresh and nutritious meals most of which were home made. Special diets, difficulties with swallowing and specific difficulties experienced by residents with dementia were clearly taken into consideration when providing meals. Staff were regularly supervised. Staff had good relationships with residents. Robust procedures were in place for safeguarding any money residents wished to hold in the safe. What has improved since the last inspection? Significant effort has been made to ensure that each resident has a care plan that reflects all of their current needs. Whilst training in tissue viability had taken place it was in the form of a video shown to staff and multiple-choice questions. A specialist nurse did not provide the training. Significant efforts had been made to ensure the improved quality in the comfort of the environment for residents. All of the stained carpets to the corridors which housekeeping staff had struggled to keep clean had been replaced. All of the corridors were being painted. One bathroom which had been out of use for some time had been refurbished with a new specialist bath. As a consequence those residents living on that unit did not have to travel far for a bath as they had in the past. Mrs Watts had submitted proposals to the organisation to replace 6 toilet bowls and for the installation of a sluice at the top end of the building. All staff had access to the training in dementia care although no further dementia training was identified in the yearly plan. Mrs Watts had put together a library on related subjects with information gained from the internet. A computer had been installed for staff to access the E learning Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 7 provided by the organisation. Mrs Watts was due to take place in a video conference with a well known speaker on dementia care. Senior staff have time allocated on the staffing rota to enable them to carry out their administrative duties. What they could do better: The organisation’s current format for pre-admission assessments does not support staff to carry out a full assessment and record in sufficient detail all of the care and support needs of potential residents. Staff have to develop their own questions and write on the back of the forms or write their own assessment documents in order to compile a care plan if the placement goes ahead. The format does not recognise the need to assess the often complex care needs of those potential residents seeking a place as part of the registration category for dementia. The format does not provide for staff to state where the information was sought or to date the assessment as evidence that it was completed before the person was admitted. The term ‘mental health’ should not be used in care plans as it could suggest that the home is registered for this category which it is not, only dementia. Whilst the staff were compiling care plans to identify those residents who had the potential to be at risk of developing pressure sores, there was no formal assessment document in place. The home had taken part in a pilot study with the Tissue Viability Specialist Nurse earlier in the year and had done assessments on those residents. However the tool, specially developed for non-nursing care staff to assess the early indicators of risk, had not been used for any subsequently admitted residents. Before the pilot commenced, the organisation had given the Commission assurances that a suitable assessment format for assessing residents’ risk of developing pressure sores would be in place. This was as a result of a previous format being removed. The home was advised to use body maps detailing size, colour and whether the skin was broken to show evidence of healing of any wounds. The home must request alternative formulas of medication if residents find difficulties in taking tablets. If alternative mediums cannot be sought then written rather than oral instructions must be obtained when the prescriber authorises medication to be crushed. The home may be at risk of rendering medication unlicensed or altering the dose by crushing tablets. The organisation does not have a policy on providing intimate personal care by staff of a different gender. However, some female residents had their preference recorded in their care plan. Only 20 hours each week had been allocated to a member of staff to provide activities for 50 people. They achieved a good range of both group and individual activities during the allocated time. The weekly programme provided group or individual activities. However the extensive programme Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 8 shown to the inspector meant that either care staff were expected to provide activities or that events did not occur. Some staff were not immediately aware of the correct procedure for reporting allegations of abuse and had to be prompted. Whilst the local procedure booklet was available in the home, records showed staff had been trained in abuse, rather than the Wiltshire and Swindon Vulnerable Adults procedure. Staffing levels were minimal given that the home extends through 5 different areas. Whilst 2 part time staff had been employed to support the care staff with providing meals, laundry and some cleaning, this was only during the mornings. Care staff were expected to carry out these duties during the afternoons and evenings. The home should obtain a copy of the latest guidance on infection control in care settings published by the Health Protection Agency. 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.V311152.R01.S.doc Version 5.2 Page 9 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.V311152.R01.S.doc Version 5.2 Page 10 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 The Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Whilst the home was carrying out their own pre-assessments, the organisation’s format meant staff had to develop their own questions and observation tools to assess whether care needs could be met. The format did not address the often complex care needs of people with dementia or show where the information came from. EVIDENCE: Pre-admission assessments were being carried out with all potential residents and those residents who had spent a period of time in hospital. However the organisation’s form was one for determining funding and did not give sufficient information to compile a care plan. Another form was also used but did not allow the assessor to gain sufficient information to compile a care plan. Staff needed to either write on the back or write separate assessments, to give more personal details. The form did not allow for assessment of the often complex care needs of those potential residents who may have a dementia. Neither did it allow for the signature of the assessor, the date of the assessment or where the information was gained. The form relied on the assessor being skilled in asking the right questions to decide on whether the Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 11 potential resident’s care needs could be met. The inspector saw evidence that the home did not receive residents back from hospital without their own assessment of whether the residents’ needs could be met. One resident said that they had had an assessment before they came to live at Buckland Court. Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 12 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 The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Significant efforts had been made to ensure that all residents care needs were identified in their care plans. Residents had good access to healthcare professionals. Staff were prompt at alerting any concerns regarding residents health. Some residents had been assessed as able to administer their own medication. Staff upheld residents’ rights to privacy and dignity. EVIDENCE: Significant efforts had been made to ensure that all residents’ needs were identified in their care plans. The care plans now showed a good picture of how the care was to be delivered. There were some minor additions that needed to be included, for example, the use of a spray for angina and a risk assessment for a resident who smoked. The inspector advised staff to avoid the use of the term ‘mental health’ in care plans, as the home was not registered under this category, only old age or dementia. All residents were regularly weighed and any significant loss referred to the GP. Food supplements were in evidence where needed. Food and fluid intake charts would be completed if concerns were noted. There was good evidence of meeting variable need, for example, guidance to staff in a care plan which identified that the resident would only need help to wash and dress in certain Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 13 circumstances. Another care plan identified that a resident would sometimes need wheelchair assistance rather than walking the long distances from their room to the communal areas. One resident had their care plan revised during a period of ill health. Other care plans gave guidance to staff in dealing with behaviours. Some action had been taken to address the requirement that each resident had a written assessment of their risk of developing pressure sores and training and advice was sought on tissue viability. Staff had incorporated a statement of risk in the care plans. These parts of the care plans showed that staff had a better understanding of the early indicators which may predispose residents to developing pressure damage. However some files still referred to taking action when red marks appear, clearly too late. One resident’s notes showed a drawing of marks at the base of the spine. The inspector advised the use of body maps to indicate dates, description of the wound including size, colour and whether the skin was broken, to show monitoring of healing. The home had taken part in a pilot scheme for non-nursing staff to assess the early indicators of residents’ risk of developing pressure sores. The Tissue Viability Specialist Nurse who had developed the tool initiated this pilot. The home had assessed all of the residents in June and July 2006 when the pilot was undertaken but had not used the document to assess subsequently admitted residents. The organisation, earlier in the year, before the trial, had given the Commission assurances that a suitable assessment tool would be in place. However this was not the case. The tissue viability training took the form of a video shown to staff and multiple-choice questions. It was not carried out by a specialist nurse. Pressure relieving mattresses and cushions were in place for some residents where needed. Residents had good access to healthcare professionals. One resident said they would ask the care leader if they could arrange for their GP to visit and this was promptly attended to. Another resident said staff would arrange for a voluntary driver to take them to hospital appointments. There were regular visits from the district nurses. Any invasive treatments were carried out by the district nurses. One of the residents said that no one was allowed to keep medicines in their bedrooms and staff would give tablets. Records and the medication policy showed that residents could administer their own medication following a risk assessment. Staff monitored those residents who administered their own medication each month. Another resident said they were given their prescribed pain killer whenever needed. One of the residents had a sublingual spray medication prescribed ‘when required’ with no guidance in the care plan for when it should be given or what symptoms should prompt administration. However other care plans identified when painkillers should be administered and how certain behaviours had indicated an infection in the past and medical advice should be sought. Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 14 One of the care leaders showed the inspector the arrangements for the administration and control of medication. They were not the care leader with the delegated responsibility for medication but had a very good detailed knowledge of the systems and was able to explain all of the arrangements. New staff could not administer medication until they had undertaken a period of induction, been given training in administration of medication and were deemed competent to do so. Other staff who gave medication were regularly monitored as to their continued competence to administer the medication. The medication administration records were being very well kept. All handwritten entries where medication may have changed or was newly prescribed being witnessed, signed and dated. A record was kept of the disposal of all unwanted or unused medication. All medication accompanying newly admitted residents was checked with the prescriber before administration. No controlled drugs were prescribed although Temazepam was being stored and administered as such. The inspector advised that the specific prescribing details of some medication to be taken ‘when required’ or ‘before food’ should be written in residents care plans. Where the prescriber had given staff oral instructions to crush medication and place on food, the home was advised either to ask the prescriber to supply the medication in an equivalent liquid or soluble form or obtain written confirmation that the medication can be crushed. The home were at risk of rendering medication unlicensed or altering the dose by crushing tablets. All eye drops or inhalers were discarded and replaced on a monthly basis. Topical creams were kept in individual bedrooms. As a matter of good practice the home had a recent copy of the British National Formulary published by the British Pharmaceutical Society. This enabled staff to familiarise themselves with the properties of residents medication. The care leader said that all prescriptions for newly prescribed medication would be obtained immediately after the GPs visit. Residents were well groomed with clean hair, teeth, glasses and clothing. Many of the ladies regularly had their hair done and the hairdresser was visiting on the second day of the inspection. All of those residents visited in their bedrooms had their call bells within easy reach. They also had a jug of juice with a glass so they could have additional fluids. The juice was changed mid morning. Staff were seen to be very respectful of residents and good relationships had been developed. All personal care interventions took place behind closed doors. Buckland Court DS0000028269.V311152.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Only 20 hours are allocated to activities each week for 50 residents. However the person providing activities does offer a good range of group and individual sessions in the time allocated. Visitors were welcomed. Those residents who were able could make decisions about their lives. Other residents had to rely on staff or family to advocate for them. The chef provides an excellent choice menu with fresh ingredients and home made cooking. The chef was very aware of how to encourage those residents who may have difficulties in eating to have a healthy diet. EVIDENCE: There was only 20 hours each week allocated to a member of staff responsible for the provision of activities. This allows very little time each week per resident given that the home is registered for 50 people. Whilst it is recognised that there is also a separate day service where residents can join in with their activity programme, this amount of time would not be sufficient for the programme of activities shown to the inspector. Activities were proposed for mornings, afternoons and evenings, 7 days a week, including some one to one time. Care staff were expected to provide the other activities on the programme. Activities would be allocated to care staff at the handover. It was clear from talking to the member of staff responsible for activities that in the limited time available a remarkably good range of activities was provided each Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 16 day. They said that activities were not restricted to being provided in the home; they intended to take groups out in the locality as much as possible. There was a minibus at one of the nearby homes in the organisation that could be borrowed, but staff had to drive to this home to pick it up. Alternatively taxis would be hired; paid for by the amenity fund. Residents would be invited to other local homes in the organisation for quizzes or beetle drives. Sometimes residents would enjoy just a drive in the countryside or to the surrounding villages rather than have a destination in mind. A local friends group took some residents out for a drive each month. Some residents attended the local stroke club and other clubs at the Community Centre. The member of staff responsible for activities showed the inspector the record they kept of what was provided each day and who attended. They said that they would ask new residents what they enjoyed doing and would tailor individual programmes accordingly. Some of the activities included: crafts, going to a local café, bingo, sing songs, card games, board games, manicures, gardening in the summer and cooking. There would also be word games, reading the newspaper and discussion about various topics. Calendar events and themed days were celebrated with the chef being involved in providing particular food. This included, for example, the summer solstice, with Stonehenge being about 2 miles away, Valentines Day, harvest festival and a Hawaiian day. The home had taken photographs of the various events with some residents dressed up in costumes and some sculpted food served. Local churches held different services at least once a month. Residents were currently involved in making crafts for sale in the Christmas bazaar. The activities co-ordinator reported a great deal of support from families and others in the community with fundraising for the residents amenity fund. This paid for many of the entertainments. One of the residents had been out to the local supermarket with the activities organiser to treat themselves to a bunch of flowers. Another resident went out on their own into the town. One resident said they joined in with the occasional quiz. Another said there was not a lot of activities to amuse them and they would like to be taken to the newly opened supermarket. Another resident said that the days were very monotonous and they would like more to do. Those residents who were able appeared to make many of their own decisions about their lives, how they spent their day, who with and when they got up or went to bed. All of those residents with whom the inspector could communicate said that they pleased themselves what they did and there did not seem to be any routines imposed upon them. Staff talked about residents deciding upon their own routines and that if residents wanted to spend time in their rooms without being ill they could. Staff also said that there may be occasions where they would investigate why a resident was spending time in their room if they were normally more gregarious. Staff were aware of the possibilities of residents becoming withdrawn or depressed. Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 17 It was established that when residents went out for a meal as part of an activity they would have to pay for that meal. Residents have already paid for a meal as part of their contracted fee. Residents must be refunded for the part of the meal that they have already paid for. Most of those residents spoken with said they enjoyed the quality and range of meals provided, some described the meals as excellent. Some of these residents described some of their favourite meals. They said they could have their meals in the dining room or in their bedrooms. The inspector was unable to seek the view on the food for some residents with whom they could not communicate. The chef talked about the menus which were originally compiled taking into consideration the likes and dislikes of residents. They said they would make adjustments depending on seasonal availability and the weather. They also regularly talked with residents about their likes and dislikes. The chef talked about the meals they had prepared at part of the themed days described by the activities co-ordinator. All of the soups, cakes, puddings, including Christmas fare and mince meat were home made. Each resident would have a home made Birthday cake. Choice meals were served at lunch and tea with both dishes being presented to each resident at the table so they could see what they preferred. The majority of the meals were prepared from ‘scratch’ with fresh ingredients. Special diets were catered for and a roast meal during the week as well as on a Sunday. This was because those residents who came for day services particularly enjoyed a roast. The chef said that if residents have difficulties with eating or swallowing then the different components of the meal will be mashed or liquidised separately so that the meal is still appetising. Some residents had meals that they were able to eat with their fingers if they had lost the ability or forgotten how to use a knife and fork. The chef was able to give many examples of which residents had benefited from this and gave examples of residents who may not have speech yet really enjoyed certain meals. The inspector was pleased to note that the chef had a good understanding of how residents with dementia should be encouraged to eat. It was clear from discussions that the chef and the other kitchen staff enjoyed providing good quality meals for residents. All of those residents who were seen in their bedrooms had a jug of juice and a glass within their reach which was regularly changed. Risk assessments identified encouraging residents to drink during the hot summer weather. Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 18 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 The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home takes complaints seriously and makes sure that complainants know the outcome of any investigations. Whilst reporting procedures were in place for disclosure of abuse, some staff were not immediately familiar with the process. EVIDENCE: The home works to the organisation’s policy and procedure for making complaints. The procedure is displayed in the entrance hall and copies were made available to residents and their representatives through the service users guide. One of the residents said that if they had any concerns they would talk to their keyworker or directly approach the manager. They also said they remembered having sight of the complaints procedure. Mrs Watts kept a log of any complaints which identified details of the outcome of investigations and letters to complainants. Copies of the Wiltshire Vulnerable Adults reporting procedure were seen in the home. However some staff were not immediately aware of the correct procedure if allegations were made and had to be prompted to gain the correct procedure. The recent training had been about abuse rather than the Vulnerable Adults Procedure. The inspector advised that the home must make sure that staff are aware of the procedure especially in the exceptional circumstances where the manager or senior managers may not be available for advice. Buckland Court DS0000028269.V311152.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 & 26 The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The environment has been significantly upgraded with redecoration, re-carpeting and installation of a new bathroom. The home was cleaned to a good standard although care staff were taken away from care to do any cleaning or laundry in the afternoons and evenings as housekeeping staff were only employed in the mornings. EVIDENCE: The requirement that the bathroom identified was not used for storage and was available for residents’ use had been actioned in full. The bathroom had been fitted with a specialist bath and refurbished. Residents who lived on this wing did not now have to go for their baths in other parts of the home. There was also an accessible ‘walk-in’ shower. The requirement that an action plan was submitted to the Commission detailing timescales for the replacement of the stained carpet in the corridor near the dining room had been actioned in full. All of the carpets in each of the corridors throughout the building had been replaced with good quality, Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 20 easily cleaned carpeting. The walls and paint work had been redecorated. This had made significant improvements to the comfort and quality of the environment for residents. Staff reported that one of the benefits for them had been that their feet did not ache at the end of the day. The requirement that an action plan was submitted to the Commission with timescales for the completion of refurbishment to those areas of the home in need of redecoration was in good progress. Mrs Watts had proposed that a newly recruited handyman would carry out the work. Since that time the organisation’s own contractors were in the process of completing the work in acknowledgement of the large scale of the work to be undertaken. Mrs Watts said she had also submitted proposals to the organisation to upgrade the laundry area, installation of 6 new toilet bowls and the installation of a sluice to the top end of the building. She said she was concerned that problems encountered with leaks to the roof may take priority. Hoists were available for safely moving residents. Wheelchairs were available for residents to be transported the long distances from some of the bedrooms to the communal rooms and back. It was also noted as a matter of good practice that residents who had commodes in their bedrooms were not restricted from using them during the day. The inspector had found a soiled piece of underwear in one of the toilets at the beginning of the inspection. One of the staff immediately dealt with the soiled garment. However later that afternoon when visiting the laundry the garment was found to be still soaking in a pan of water. The inspector advised that soiled linen must not be left to soak but should immediately be laundered in line with the guidance to care homes on infection control. The inspector also advised that the home should obtain the latest copy of this guidance produced by the Health Protection Agency. One of the residents described the laundry service which they said was marvellous. They were pleased to have their laundry returned within 24 hours. They were also pleased to have their bed linen regularly changed. The home was cleaned to a good standard including those areas not always visible, for example, the undersides of raised toilet seats. One of the residents described the team of cleaners, naming some them and how the work was carried out. Guidance was available and systems in place for managing infections. Protective clothing and gloves were available. A new call bell system had been installed. Risk assessments were being carried out on the environment, tasks and visits away from the home. Mrs Watts regularly reviewed these assessments. Buckland Court DS0000028269.V311152.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28,29 & 30 The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Although staffing levels are minimal, staff are committed to providing a good service to residents. Staff had good relationships with residents. Housekeeping staff are only allocated to the mornings, so care staff are expected to carry out these duties at other times taking them away from the care of the residents. Staff have good access to relevant training. Training in dementia care is accessible to all staff although there was no further dementia training on the yearly plan. Robust recruitment procedures are now in place. EVIDENCE: There were 4 care staff on duty on the first day of the inspection with 2 care leaders one of whom was covering for a staff who was sick. The care staffing rota showed that on occasions there was a member of staff working 11.00am until 6.00pm to ensure sufficient numbers during the day at weekends. Generally there were three waking night staff. Staff reported that there were 2 vacant night care posts and until they were filled, sometimes there were 2 waking night staff and a member of staff sleeping in. The requirement that staffing levels were sufficient to meet the needs of residents identified in the organisation’s own staffing proposal dated May 2005 had been actioned in part. Two part time posts had been created with the title: care support worker. This role provided an extra 4 ancillary hours each morning, including the weekends. These staff did not provide personal care, but provided some domestic support, provided drinks and helped with the laundry. The allocation of cleaning and laundry staff was across the mornings Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 22 only. During the afternoons and evenings the care staff would have to do any cleaning and laundry as well as care. There was also no kitchen staff allocated for the evenings at weekends so care staff were currently washing up after tea and supper, taking them away from the residents. Care staff were also expected to provide activities outside of the 20 hours allocated each week. Mrs Watts said that the evening kitchen post was advertised. All senior staff had a delegated area of responsibility, for example, the medication, fire safety, infection control and health and safety. They said they were now allocated time on the rota specifically for this work. The requirement that Mrs Watts must be involved in the recruitment process of staff from overseas to make sure that all of the documents and information required by regulation were in place had been actioned. Mrs Watts confirmed that she was now involved in all recruitment of new staff. The relevant documents were on file with regard to Schedule 2. Risk assessments were in place for staff who may be pregnant. The 2 care leaders said they had recently undertaken dementia training and that 4 staff had undertaken the 2 day course the previous day. They said that it was intended that all staff were to complete the course. The administrator said that they would like to undertake the training because they had contact with all the residents and some who may have a dementia would often come and see her in her office, so she would like to have more of an understanding of the condition. Mrs Watts confirmed that all staff would eventually have training in dementia care and this was confirmed by the individual training records which identified dementia training as one of the core subjects. However there was no other future training in dementia care noted on the training matrix. Mrs Watts said she had put together a library on related subjects with information gained from the Internet. Staff said there had also been some in house training provided by Mrs Watts. This included abuse, health and safety and risk assessment. Mrs Watts said that the organisation had provided a package of E learning and time would be set aside for individual staff to use the newly installed computer for this purpose. Currently the induction of new staff was completed using this tool. Staff had individual training records highlighting mandatory training for each different role. One of the care leaders was the person responsible for infection control and would be providing regular training to staff. The inspector advised that the home should obtain a copy of the latest Health Protection Agency’s guidance to care homes on infection control. Another member of staff was the home’s trained trainer in moving and handling and regularly trained all staff. Staff said they had received training in diversity and equality. They talked about how they applied the training to their work, particularly the difficulties in challenging those residents who may be racist towards black staff. Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 23 The home employs male staff. The organisation does not have a policy on residents receiving intimate personal care from a carer of a different gender. However there was evidence in the majority of residents care plans that they had been asked their preference. This issue was discussed with one of the female residents who said that they did receive some personal care from male staff but they preferred to have a female staff. This resident’s file stated that they had no preference which was clearly incorrect. All of those residents with whom the inspector could communicate said that they enjoyed good relationships with staff. This was evident from observations throughout the 2 days. Many of the residents described their particular keyworkers. Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 24 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): 31, 33, 35, 36 & 38 The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Mrs Watts has put much effort into developing and improving the service to residents. The home is run in the best interests of residents. Quality assurance systems are in place. Robust systems are in place to ensure good management of any money held on residents’ behalf. Staff are regularly supervised. Systems and checks were in place to ensure the health and safety of residents. EVIDENCE: Mrs Watts had managed the home for over 2 years. She has had experience of working in care homes for younger adults as well as older people. It was clear from the improvements noted in this report that Mrs Watts had together with the staff team, developed and improved the service to residents. Mrs Watts said that she was due to undertake dementia training in the form of a video conference with a well known speaker on dementia care. Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 25 As part of the home’s quality assurance assessment, questionnaires had been filled out by a number of residents asking them about the accommodation, the catering, the care and support, activities and access for visitors. The results had been collated and a report published on the percentages of residents that were satisfied with the service. It was not possible to establish from the report what the issues were where residents were not satisfied with the service, save that the issues would be discussed at the residents meeting. Given that the home is registered for 18 places for residents with dementia, it was not clear how their views were sought. Mrs Watts confirmed that if residents were not able to communicate staff would find other means to seek their views, including gaining a social history from family. Mrs Watts said she could develop pictorial questionnaires similar to those she had used with people with learning disabilities in her previous post. Minutes of residents meetings were seen. One of the residents confirmed that they went to the meetings that were held every few weeks. A representative from the organisation had carried out an internal audit of the home in February 2006. Reports of the unannounced visits required by Regulation 26 were on file. Staff were regularly supervised confirmed by a programme and notes in staff files. Senior staff said they each had a group of staff they would offer supervision to and were in turn supervised by Mrs Watts. Supervision took place every 6 weeks. 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. The forms entitled long term care plan and assessment, removed by the line manager on request had been replaced. An internal audit was being carried out of the home’s financial arrangements on the first day of the inspection. The home’s administrator explained the arrangements for holding any money on residents’ behalf. Residents may keep small amounts of cash in the home’s safe. Records and receipts were kept of all transactions. Two signatures were required for withdrawals if residents were unable to sign themselves. Only the administrator and Mrs Watts had access to the safe. If residents wanted access to their money at the weekends when neither was on duty, special arrangements would have to be made to either have their money on a Friday or for the money to be secured elsewhere so that care staff could give it to them. Mrs Watts and the administrator regularly audited the holdings. The administrator was only responsible for 2 residents pensions and records were kept of these transactions. Most residents managed their own finances. Where residents were unable to do this their family was encouraged to be responsible. The local authority or a solicitor managed finances if residents had no family and could not manage their own finances. Only a small amount of valuables were held on residents behalf with records kept. Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 26 Risk assessments were carried out on the environment, use of equipment and tasks that staff may be involved with. Individual risk assessments were found with residents care plans. Mrs Watts regularly reviewed the assessments at least once a year on a cyclical basis. Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 27 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 28 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. Standard OP8 Regulation 13(4)(c) Requirement The person registered must ensure that each resident has a written assessment with regard to their risk of developing pressure sores. (In progress, assessments were in place but did not show evidence of how the risks were identified) The person registered must ensure that tissue viability training is carried out by a suitably qualified person. The person registered must 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 Commission must be provided with an action plan with timescales for when these proposals will be met. The person registered must ensure that housekeeping hours are allocated throughout the week to ensure that care staff DS0000028269.V311152.R01.S.doc Timescale for action 31/01/07 2 OP8 18 (1)(c)(i) 28/02/07 3. OP27 18(1)(a) 28/02/07 4 OP27 18(1)(a) 31/01/07 Buckland Court Version 5.2 Page 29 5 OP3 14 & 17 6 OP9 13(2) 7 OP2 4&5 8 OP18 13(6) 9 OP26 13(3) 10 OP18 13(6) are not taken away from their work with residents. The person registered must ensure that pre-admission assessments capture and record all of the needs of potential residents, including those residents who may not be able to tell the assessor what their needs are. The form should also record the source of the information and be signed and dated. The person registered must ensure that where a prescriber had given verbal instructions to crush medication and place on food, that either an equivalent liquid or soluble medication is requested or written confirmation of this unorthodox method of administration must be obtained. The person registered must ensure that if residents have a meal out as part of an activity, they do not pay for that part of the meal that they have already paid for as part of the fee. The statement of purpose, service users guide and contracts must state those items covered by the fees and those items that residents will have to pay for. The person registered must ensure that all staff are aware of the local reporting procedure for allegations of abuse of vulnerable adults. The person registered must ensure that staff have an understanding of infection control guidance with regard to soiled laundry. A copy of the latest guidance issued to care homes by the Health Protection Agency must be obtained. The person registered must DS0000028269.V311152.R01.S.doc 15/11/06 22/11/06 15/11/06 15/11/06 15/12/06 31/01/07 Page 30 Buckland Court Version 5.2 ensure that a policy is in place with regard to the carrying out of intimate personal care by staff of a different gender to the resident. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Details of certain medication and guidance should be added to care plans, for example, medication for angina, medication prescribed ‘as required’ and ‘before food’ together with a smoking risk assessment. Consideration should be given to providing extra staffing hours for the provision of those activities in the activity programme. Consideration should be given to avoiding the term ‘mental health’ in care plans as the home is not registered for this category of registration. 2 3 OP12 OP7 Buckland Court DS0000028269.V311152.R01.S.doc Version 5.2 Page 31 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.V311152.R01.S.doc Version 5.2 Page 32 - 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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