Inspection on 30/04/08 for Bullsmoor Lodge

This inspection was carried out on 30th April 2008.

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

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

Bullsmoor Lodge 30/04/07

Bullsmoor Lodge 13/06/06

Bullsmoor Lodge 12/01/06

Bullsmoor Lodge 19/09/05

Bullsmoor Lodge 31/01/05

Bullsmoor Lodge 11/05/04

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

CARE HOMES FOR OLDER PEOPLE Bullsmoor Lodge 35-49 Bullsmoor Lane Enfield Middlesex EN3 6TE Lead Inspector Jackie Izzard Unannounced Inspection 30th April 2008 09:00 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 Bullsmoor Lodge DS0000010662.V362847.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. Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bullsmoor Lodge Address 35-49 Bullsmoor Lane Enfield Middlesex EN3 6TE 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) 01992 719092 01992 650603 bullsmoor.manager@btinternet.com Scimitar Care Hotels Plc Angela Christine Dickson Care Home 48 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (48) of places Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP 2. Dementia - Code DE (maximum number of places: 6) The maximum number of service users who can be accommodated is: 48 6 December 2007 Date of last inspection Brief Description of the Service: Bullsmoor Lodge is a modern purpose built home owned by Scimitar Care Hotels. There are four homes belonging to this organisation. The home is registered to care for forty-eight people of either gender who are over the age of sixty-five, six of whom have may have a diagnosis of dementia on admission to the home. The main lounge, dining room and kitchen are on the ground floor. All but three rooms are single and have en-suite toilets. There is an attractive garden to the rear of the house. There are two lifts that give access to all floors. The home aims to provide support and care in a homely environment. Fees are between £450 and £ 800 per week. At the time of this inspection, there were forty-three people living at Bullsmoor Lodge. This report is available through the internet. Copies may also be obtained from the provider of this service. Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 5 Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection took place on 30th April 2008 and lasted eight hours. I inspected the building and examined the care and health records for six residents and files for five staff members, plus a selection of other records in order to assess whether the home was providing a good service to the people who live there. I was able to meet a number of residents and also spend a period of time observing what goes on in the home. A meal time, an activity and interaction between staff and the residents were observed. Discussion took place with the manager of the home, one resident’s visitor and a number of residents. In addition questionnaires were sent by CSCI to the home for residents and staff. Feedback was received from one resident. The majority of residents said they were very happy with the care and support they receive at this home. What the service does well: Bullsmoor Lodge has a friendly atmosphere. The manager and staff are committed to providing a very good level of care to all residents. The staff understand the needs of residents and work hard to meet these needs and form a good relationships with them. One resident said, “I can’t complain, they look after me very well. The girls are very nice, always smiling.” People are treated as individuals and ere encouraged to be as independent as they wish. One resident said, “ they look after me well and they let me do what I like.” The manager of the home is professional and committed to providing a caring and supportive environment. Staff are appropriately trained for the work they carry out. Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 7 The home is well maintained and decorated and furnished to a good standard. Residents said they appreciated that the home is kept so clean and one confirmed that s/he had chosen the decor for his/her own bedroom. What has improved since the last inspection? What they could do better: At the last inspection of Bullsmoor Lodge in December 2007, four requirements were made. These are areas that Scimitar Care Hotels and the manager of Bullsmoor Lodge needed to improve in order to meet National Minimum Standards and improve the service offered to residents. None of these four requirements had been fully completed and this is of concern. These requirements have been restated in this report. Unmet requirements impact on the health and safety of residents and must be complied with. Failure to do so may result in the Commission for Social Care Inspection taking further action to ensure compliance. The requirements relate to protecting residents from the risk of fire by ensuring bedroom doors are not wedged open without undertaking risk assessments and to ensure that night staff have undertaken a fire drill to practice what they need to do if a fire were to occur at night. The requirement to cease wedging fire doors open and install automatic door closer devices for fire safety reasons has been restated by CSCI inspectors three times. It is of concern that this home has continued to take risks with residents’ safety in this way. A few days after this inspection, the manager and operations director advised that they had removed all door wedges from the home, completed the risk assessments and ordered automatic closing devices for those residents who wished to keep their door open. A requirement to publish the results of quality assurance surveys and make these available to residents and potential residents has not been met which means that residents do not know what has happened to the questionnaires that they completed for the company. Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 8 The fourth requirement was to ensure that residents’ photographs are attached to their individual medication charts to help staff identify residents and minimise risk of error when giving medication. This has still not been completed. Five new requirements have been made as a result of this inspection. One requirement is to assess, record and meet the health and nutritional needs of a named resident. This will ensure that staff can give the best support to this person with eating and drinking. Inadequate recording of this person’s health history/needs, what s/he likes to eat, what s/he is actually eating and a weekly record of his/her weight as advised by a GP means this person could be at risk of his/her health needs not being met. A requirement is also made that the registered provider, Scimitar Care Hotels, fulfil their legal requirement to undertake unannounced monthly visits to the home and produce a report on the conduct of the home giving a copy to the manager and to CSCI. This external monitoring of the home is required to ensure that the manager is supported and that the home is being run in the best interests of residents. A requirement is made to ensure that the fire alarm system is tested every week as there was a four-week gap in the records. This is necessary to ensure that residents are protected from risk of fire. The final requirement is made to ensure that the trolley which holds the home is cleaning materials is never left unsupervised as this could pose a risk to any confused resident who could accidentally spill or swallow the cleaning fluids. A recommendation is also made to update the companys recruitment procedure and detail good practice in obtaining and checking staff references which will help to ensure that all future staff employed have all the appropriate checks before commencing work at the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bullsmoor Lodge DS0000010662.V362847.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 Bullsmoor Lodge DS0000010662.V362847.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential residents’ needs are assessed before they move into the home so that they know the home is aware of their needs and can meet them. They are given enough information to make an informed choice about moving to the home. No intermediate care is provided. EVIDENCE: In order to assess the standards, six assessments were examined. Three of the assessments were for people who had recently moved into the home. One resident moved into the home during the day of the inspection and the assessment which was being carried out was recorded beforehand plus a senior member of staff continued the assessment process with this resident during the inspection and recorded his/her wishes and needs into a care plan Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 11 within hours of their arrival into the home. This is good practice as it ensures that staff are aware of the persons needs and preferences as soon as they move in. All these assessments were carried out by the manager or other staff from home. The format of the assessments was satisfactory and addressed the residents’ needs when supplemented by an assessment from the local authority responsible for the person’s placement at Bullsmoor Lodge. A relative of one resident said that the resident had stayed at the home for periods of respite care on a number of occasions before making an independent choice to move into the home on a permanent basis. A fewl of the permanent residents had made the choice to move there after staying at the home for periods of respite care previously and felt that they had got to know the home well before making the decision to move in. The manager went out to assess the needs of a potential resident during this inspection. Potential residents and their relatives are encouraged to visit the home and the manager explained that she supports relatives in the process of explaining to a resident why they have to move into a residential care home. When potential residents are visited for an assessment the manager said that she takes written information about the home for them to read. This includes the Statement of Purpose for the home which was seen during the inspection. One resident said that s/he remembered being given “a leaflet all about this place.” This home is not equipped to provide intermediate care but provide respite care where people can come to stay for a few days or a few weeks. I was able to speak to two people currently staying at the home for respite care who considered they had been given adequate information about the home before coming. For one of the six assessments which were inspected, information regarding a persons health had not been recorded in the care plan and insufficient information regarding the person’s eating habits and preferences had been recorded. This issue is addressed in the health and personal care section of this report. Bullsmoor Lodge DS0000010662.V362847.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s health and care needs are set out in an individual plan of care which is reviewed regularly. Their care and health needs are generally well met by the home. One person’s health and care needs were not up to date in the care plan and advice from the GP had not been fully acted on, leaving this person at risk of his/her health needs not being met. EVIDENCE: To assess these standards six residents’ records were inspected for evidence that the home knows their needs and is meeting them. Their care plans, reviews of the care plans, daily progress records, health care records and any other records were read and this was followed up with either talking to the person concerned or observing them at a mealtime or in their interaction with staff. Medication records for two of the six were also inspected and discussed Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 13 with senior staff. One relative and three other residents were spoken to regarding health and care practice. From reading the records of two people who have had or are at risk of pressure sores, it was evident that the home was aware of their risks and needs and had put support in place to reduce the risk of the person developing another pressure sore. Equipment such as air mattresses were in use and care plans showed that staff were expected to apply cream to high risk areas and to help the person change position regularly. The district nurses visit twice weekly and keep records of the care they provide which staff at the home are kept up to date with. The manager not acted on the previous advice from an inspector to contact the local tissue viability nurse as she considers that the advice and support received by the district nurses is sufficient to meet residents and staff needs in the area of pressure care. None of the residents had any pressure sore at the time of the inspection. One resident refuses assistance with personal care form staff but this was being properly addressed by the manager. There is no choice of male or female staff to assist with intimate personal care as no male staff are employed. The manager said that none of the residents minded this and were all happy to be assisted by female staff. One resident was asked for his views on this and said that he had no particular preference as to whether a male or female helped him. Care plans generally recorded the person’s needs well and relatives were involved in wirintg the social history personal profile about the resident. Some residents had been involved in developing their care plan and had signed it. Others had not signed it but the manager said care plans were always discussed with the resident where they were able to understand. Care plan reviews were seen to be taking place every month to see if the resident’s needs had changed at all. The care of five of the six residents whose records were inspected was well documented and appeared to be of a good standard. Two of these people plus two others were asked for their opinion on the care provided. All said they were looked after well and staff knew their individual needs and preferences well. One said, “They are marvellous, I couldn’t fault them.” A relative said that the staff care well for his/her mother including involving and consulting the next of kin with decisions about the resident’s care. Hair appointments are made as often as residents wish and records in their files showed that they have good access to all health care services. Appointments with their GPs are well documented with the outcome and any treatment given. Records also showed that residents see an optician and dentist and chiprodist regularly. Where an eye test recommended new glasses for two residents, both had been supported by staff to obtain the glasses without delay. Where a resident has to attend hospital, extra staff are rostered on so that they can be escorted. Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 14 This is good practice as many residents need support with attending health appointments. The GP visits weekly and more often if required and district nurses visit twice weekly and more often for specific needs. One person’s health needs were not recorded in her care plan though it was evident from examination of medication records that this resident had physical and mental health needs. As these were not recorded it was not clear whether staff were supporting the resident with her needs. In addition, this resident had lost a significant amount of weight. Medical records showed that a GP had asked that staff weigh the resident weekly and record what she was eating. The weekly weighing had not been carried out and inspection of the food chart showed that it was not being completed properly or overseen by senior staff to ensure the resident was receiving adequate nutrition. In practice, observation of a mealtime showed that staff were concerned about this person’s nutrition and were supportive and encouraging her to eat and drink. Inadequate recording of food and drink intake means that the manager and the GP cannot properly assess whether this resident is at risk. Her nutritional needs were not recorded sufficiently to assess that her nutritional needs were being met. A requirement is made to assess, record and meet this resident’s health and nutritional needs and preferences. The home has equipment to support residents in their personal care and this is used by staff trained to do so. Medication is stored safely in a secure room and staff are trained to administer it. On the day of the inspection, a senior member of staff was responsible for medication. She had been trained to NVQ level 3 and showed a good knowledge of what medicines were prescribed for and was observed to be giving medicines appropriately to residents. Two resident’s medication charts were inspected and found to be recorded properly. The temperature of the medication cupboard is monitored to ensure medicines are stored safely. Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can choose from a range of activities at the home. Visitors to the home are made to feel welcome and can visit at any reasonable time. Residents are helped to exercise choice and control over their lives. The food provided is of good quality but residents who need assistance with eating do not always receive individual discreet attention at mealtimes to maintain their dignity. EVIDENCE: Three residents were asked during the inspection for their opinions on the activities available at the home. Two said they were happy with the range of activities and could choose whether to take part or to leave the room. One said, “it’s boring here.” This person was more able and also new to the home so was not used to the change in lifestyle. Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 16 Residents told me they enjoyed the entertainers who visit the home as well as the outside trips that the home organised. The entertainer who arrived during the inspection involved the residents. One said they did not enjoy it but did not wish to leave the room. Others clearly did enjoy it and some were joining in with singing or dancing. There is a bar in the lounge so residents can buy drinks. A small lounge on the top floor is used for small group activities. There is an activities organiser employed. This person was booked on a course for the week after the inspection aimed to give her more knowledge about suitable activities for those residents who have dementia. This is positive and will benefit those residents. The home has a minibus for outings. One resident said s/he did not like the weekly exercises nor any of the games played but really enjoyed watching old films in the activity room on a plasma screen. I spoke with a visitor to the home in private who was very positive about the care provided to her mother. She said that drinks are offered to visitors and that relatives are consulted and involved in decisions affecting a resident, for example whether the resident would like their hair cut by the visiting hairdresser. Care plans clearly identified the need to offer choice to individuals and residents confirmed that they had choice and control over their lives. One resident said that, “I can go out if I want but I don’t” and another said that staff encouraged him to be as independent as possible. It was observed that one resident liked to open the front door and see what was happening outside. Although this resident was not able to go out alone, staff respected his choice and discreetly supervised while he opened the door to look outside. Two residents said that they can choose whether to sit in their room or with the group in the lounge and were allowed to walk freely though the home without interference. Smokers can choose whether to smoke in the garden or their bedroom. Those who need supervision when smoking were discreetly supervised by staff. There were few records of residents meetings though some meetings had taken place and feedback was given to me about the issues discussed. The kitchen was inspected. The cook on the day of the inspection was new to the home. The kitchen was clean and there was a good selection of fresh food. Lunchtime was observed as part of the inspection and a meal was taken with residents. There is a menu and a choice of main meal each day. On the day of this inspection, the choice was chicken in a tomato sauce with olives, rice and vegetables or beef with potatoes, vegetables and gravy. Dessert was rhubarb crumble and custard or ice-cream. Two of the four residents I asked about this meal said they didn’t like the chicken meal. This appeared to be because it was different to their usual meals, but it was well cooked and presented. It was evident that people’s preferences and needs as recorded in their care plan were being met during lunchtime. Some residents were seated at the table for forty-five minutes before they were served their meal. Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 17 This is a long time to wait and the manager may wish to review the process of serving the meals to see if this can be done more quickly to avoid people waiting a long time. Staff were observed providing assistance with eating. Staff were friendly, kind and caring to all residents at all times and encouraged them to eat. However, people’s dignity was always respected as they did not receive discreet individual attention with eating. A requirement is made to provide staff with a training session on providing assistance with eating. Some staff who were helping residents eat were standing up instead of discreetly sitting with the resident. Staff also moved around providing assistance to different people at the same time. One staff member was observed to give a spoonful of dinner to three different residents in turn instead of sitting and helping one at time. Another resident was fed a spoonful of food by three different staff during the meal. Residents were generally positive about the variety and quality of the food provided. Bullsmoor Lodge DS0000010662.V362847.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected from abuse by clear policies and procedures and by an appropriately trained staff team. Their views are listened to and they know how to complain. EVIDENCE: The home has satisfactory policies and procedures in relation to complaints and the protection of residents from abuse. The manager said that no complaints have been received by the home since the last inspection. This was verified by looking at the complaints book. The manager was advised to update the CSCI address within the complaints procedure as this had changed since the last time the procedure was reviewed. A book for compliments and suggestions is kept in the foyer and used from time to time by relatives. The manager writes a reply in the book as evidence that she has read and addressed the issue. The manager said that there is no use of restraint in the home. Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 19 There have been no safeguarding alerts since the last inspection. This means that there have been no allegations of abuse. Staff have been provided with training on what to do if they receive a disclosure of abuse or if they had any suspicion that a resident was at risk of abuse. A resident said that s/he felt able to complain if anything was not to his/her satisfaction and was able to give examples of where s/he had been dissatisfied and how staff had immediately resolved the problem. I met with the activities organiser who had held a meeting with a small group pf residents the day before the inspection. From discussion of this meeting, it was clear that the residents felt very confident about raising issues they were not happy with. This is positive as dissatisfaction can then be addressed quickly before the matter becomes a complaint. Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents enjoy a home which is clean, comfortable and maintained to a good standard but their safety is compromised by the registered persons not complying fully with fire safety requirements. EVIDENCE: The manager showed me round the home and all communal areas plus a selection of bedrooms were inspected. The home was clean and decorated to a good standard and has a homely atmosphere. Furnishings were of good quality including attractive lampshades and other homely touches. Residents said they were happy with the facilities and had been encouraged to personalise their rooms. The activity room was mentioned by two residents as being a nice room where films could be watched quietly without interruption. One Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 21 person said s/he enjoyed looking at the garden though hadn’t been in it yet. There are three shared rooms but at the time of the inspection all these rooms were being used as single rooms. The home is in the process of converting a bathroom into a wet room where residents can have a shower. There is no date given for completion of this room and residents would appreciate knowing when it would be completed. There are five bathrooms available for use. A number of bedroom doors were being wedged open. This can be dangerous, particularly at night, as residents would not be appropriately protected from smoke if there were a fire in the home. This has been an issue at the past three inspections and requirements made which have not been fully complied with. This matter is addressed under the management section of this report and a requirement made to undertake risk assessments and keep doors closed or fit an automatic closer. During a tour of the building a trolley containing cleaning chemicals was left unattended. This could present a risk to residents, particularly for those people with dementia who may not understand the liquids are harmful. A requirement was been made a year ago that no cleaning chemicals are left unattended in the home at any time and this practice should have ceased then. This requirement is repeated. Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from being cared for by staff who know their needs well and are trained to further enhance their knowledge and skills. EVIDENCE: Staffing levels were discussed with the manager who confirmed that there should be eight carers in the morning, six in the evening and three waking staff at night. Extra staff are rostered on duty when a resident needs to be escorted to a hospital appointment. I confirmed that there were sufficient staff on duty on the day of the inspection. Two residents were asked for their views on staff and periods of observation were undertaken where staff interaction with residents was observed. Staff clearly had formed very good knowledge of residents’ needs and preferences and good interaction was taking place. Staff showed they understood the individual needs of the residents in their care. Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 23 There is a head of care on each shift plus a senior care staff to supervise the other staff so that the manager is free to undertake management duties. There are two heads of care and the manager said this is working well. The company’s training, development and safety manager was visiting the home on the day of the inspection and informed that approximately 70 of care workers have now completed NVQ level 2 or equivalent. Nine others are starting NVQ 2 training next month. This is very positive and exceeds requirements. This benefits residents as staff who have completed this training have better knowledge and skills about good care practice. The senior care assistant on duty told me that she had NVQ 3. I examined five staff files from three staff recently employed at the home and two staff who have worked at the home for some time. All five had completed or were in the process of induction training which is very positive. The home’s recruitment procedure was dated 2001 and did not specify that the company expected at least one refence for new staff to be from their last employer though the application form did indicate this. Of the three new staff whose files were examined, one had only one written reference on file ( the manager forwarded a second personal reference for this person after the inspection) and none from last employer. Criminal Record checks had been undertaken before the staff were employed and were available for inspection. A recommendation is made to review and update the recruitment procedure to ensure it reflects good practice in respect of obtaining and checking references. Bullsmoor Lodge DS0000010662.V362847.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager of the home is qualified and experienced and knows the residents very well. Residents have some opportunities to have a say in how the home is run, but do not receive feedback from the registered persons when they give their views as the quality assurance process is not robust. The home is not being formally monitored as required by the registered provider to ensure it is being run in the residents’ best interests. Residents’ financial interests are safeguarded and their health and safety generally well promoted but they are being put at risk as they are not properly protected from risk of fire. Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager has been in post for five years and worked at the home for five years before becoming manager. She knows the home, staff and residents’ needs well. The manager said she has just completed her Registered Managers Award training and is awaiting her certificate. There is a quality monitoring system in place at the home and I saw questionnaires for residents as well as other stakeholders. A requirement was issued in April 2007 that the results of any quality monitoring must be published and made available to all interested parties. This requirement still has not been complied with. Residents have not had the opportunity to see any results of their feedback. A large number of surveys sent by CSCI were present in the home, some having not been given out to residents or their relatives. There was some evidence that residents meetings take place at the home but notes of the last two meetings were not written up and only involved a small group of residents. Progress has been made on the issue of consultation but more residents need to be consulted on the running of the home and the minutes of meetings should be made available to them, along with the action the manager and/or the company intends to take regarding their feedback. The last minutes recorded were from August 2007 and there was no record that residents had been given any feedback to address the issues they raised in the meeting. The activities organiser gave feedback verbally from the recent residents’ meeting and it was clear that residents should receive a reply as they raised some concerns. A requirement relating to quality assurance has been made for the second time. The home does not usually hold money on behalf of residents. The manager said that the company will open an account for a resident if this is required. Those people who can look after their own money have lockable drawers in which to store it. Relatives manage the finances of most others. The manager said that she will authorise payment of item/ services from the home’s money and the relative will then be sent an invoice to repay the home on the resident’s behalf. A small selection of health and safety records were examined. These were generally satisfactory and there were improvements in the recording of fire drills as a result of a requirement made at the last inspection by CSCI. The most recent drills were recorded as taking place in April 2008 and December 2007 which is positive. Despite it being the subject of a requirement from CSCI, the home had still not included night staff in fire drills so a requirement is made to ensure this takes place to ensure staff working at night understand what they have to do to protect and safeguard residents in the event of a fire. Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 26 Records indicated that staff have been provided with the required health and safety training. Evidence that the home has had the water tested for legionella was sent to CSCI earlier this year. Scimitar Care Hotels plc, as the registered persons responsible for the running of the home, are required to undertake monthly unannounced visits to the home and report in writing on the conduct of the home. This has not been taking place regularly as required. The last report in the home was for eleven months previously in June 2007. Another report was emailed to the inspector for July 2007. No reports were available after this date and it was confirmed to the inspector that a number of these visits had been missed. The company is therefore not monitoring the home as required and a requirement is made to ensure that this monitoring is resumed immediately and a copy of the reports sent to CSCI and to the manager of the home every month. Fire alarm tests had a gap of four weeks which is not acceptable as this puts residents at risk. A requirement is made to ensure the system is tested and working properly every week. Despite previous requirements made by CSCI, this home is failing to protect residents from risk of fire as staff continue to wedge open bedroom doors which are fire doors. These door wedges were observed in at least seven residents’ rooms. A requirement to ensure risk assessments were in place where a resident wished to have their door open had also not been complied with. Following this inspection, the manager and operations director of Scimitar Care Hotels confirmed that the risk assessments were completed immediately after this inspection, door wedges removed from the home and automatic door closers ordered for those residents who wish to leave their door open, to be delivered the week after the inspection. Bullsmoor Lodge DS0000010662.V362847.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 uCHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Bullsmoor Lodge DS0000010662.V362847.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 OP7 Regulation 15(1), (2)(b) Requirement Timescale for action 30/05/08 2. OP9 13(2) The registered persons must ensure that the health and nutritional needs of a named resident are assessed, recorded and met and advice from the GP followed by staff in order to meet this person’s needs. The registered persons must 15/06/08 ensure that the resident’s photograph is attached to their individual MAR chart to assist staff in identifying them. This requirement is restated. Previous timescale of 01/01/08 not met. The registered persons must ensure assistance provided with eating is done so in a discreet, individual and sensitive way at all times. A training session on best practice at mealtimes must be provided to all staff. 3. OP15 12(4)(a) 30/07/08 Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 29 4. OP33 26 5. OP33 24(2) The registered provider must ensure that he or a representative undertakes monthly unannounced visits to the home as detailed in Regulation 26 of the Care Homes Regulations 2001 and provides a monthly written report on the conduct of the home. A copy of each report must be sent to the manager of the home and the CSCI on a monthly basis. The registered person must ensure that the results of any quality assurance surveys are published and made available to all interested parties. This includes residents and potential residents to the home. This requirement is restated. Previous timescale of 15/06/07 not met. 30/05/08 15/07/08 6. OP38 23(4) The registered persons must ensure that night staff undertake a fire drill. These fire drills must be recorded. This requirement has been amended and restated. Previous timescale of 30/05/07 not met. The registered persons must ensure that the fire alarm is tested every week to ensure there are adequate arrangements of detecting fires. 30/06/08 7. OP38 23(4)(v) 30/05/08 8. OP38 13(4) The registered persons must ensure that cleaning chemicals DS0000010662.V362847.R01.S.doc 30/05/08 Bullsmoor Lodge Version 5.2 Page 30 9. OP38 23(4) are not left unattended at any time. The registered persons must ensure that an automatic door closure device is installed on any bedroom door where the resident wishes to leave their door open. Until this has been completed individual risk assessments must be copied to CSCI for all those residents concerned. (Timescale of 30/01/07, 30/05/07 and 01/01/08 not met). This requirement has been amended and is restated. 30/05/08 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 OP29 Good Practice Recommendations 1 The registered persons should review and update the recruitment procedure to ensure it reflects good practice with regard to obtaining and verifying references. Bullsmoor Lodge DS0000010662.V362847.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Contact Team 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bullsmoor Lodge DS0000010662.V362847.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. 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