Inspection on 10/10/06 for Bulmer House

This inspection was carried out on 10th October 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bulmer House 12/06/07

Bulmer House 23/03/06

Bulmer House 08/08/05

Bulmer House 08/02/05

Bulmer House 12/07/04

Bulmer House 05/03/04

Bulmer House 02/02/04

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Bulmer House 4 Ramshill Petersfield Hampshire GU31 4AP Lead Inspector Anita Tengnah Unannounced Inspection 10th October 2006 10:00 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 Bulmer House DS0000037250.V314363.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. Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bulmer House Address 4 Ramshill Petersfield Hampshire GU31 4AP 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) 01730 261744 Hampshire County Council Mrs Maxine Dyer Care Home 44 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (44) of places Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 08/08/05 Brief Description of the Service: Bulmer House is a purpose built residential home providing accommodation and personal care for up to 44 older persons, 23 of whom may have dementia. The home is part of a resource centre and a day service owned and run by Hampshire County Council and is located at one end of the complex. The residential area is made of a two -storey building that is separated into five units within the building. The kitchens, laundry area, small library area, large reception area, hairdressing room and treatment room are located on the ground floor together with two of the residential units. All of the residential units have their own sitting rooms, kitchen dining area and communal bathrooms. All of the bedrooms are for single occupancy. On the ground floor one of the units is for ten beds and the other for eleven. On the floor above are three units; two with eight beds the other with seven for the residents with dementia. The current fees charged is between £392- £434. Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A fieldwork visit was undertaken over a day on the 10th of October 2006. The process included a tour of the service when a number of the bedrooms, communal areas, kitchen, and bathrooms were viewed. Staff practices were observed; service users and staff records were examined. As part of the case tracking a number of the service users, staff, a visiting hairdresser and other visitors were spoken with and their views sought. There were thirty-eight permanent service users and two service users were receiving respite care at the time of the visit. What the service does well: What has improved since the last inspection? What they could do better: The home has a pre-admission assessment process in place, however not all the service users had been assessed prior to care being provided. Care plans and risk assessments were lacking in some of the care plans seen at the time of the visit. Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 6 There were a number of creams/ ointments found in different parts of the home that were not labelled and has the potential of being used as communal and pose risks to the service users. A review of hand washing facility for carers is needed in order to comply with infection control practices. The complaint procedure available to the service users should contain the details of CSCI. There were offensive odours in some parts of the home that need to be looked at and rectified. Staffing level was raised as an issue for staff and the service users at the time of the visit. This included inadequate domestic hours. 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. Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to the service. The pre admission process needs further development in order to ensure that the home can meet the needs of all the service users admitted. EVIDENCE: A sample of two newly admitted service users’ records was seen as part of case tracking. One of these contained the pre-assessment record including care manager’s assessment that was also available. Staff reported that these assessments are used as part of the care planning. However the record of another service users did not contain any assessment and care was being provided from the care plans that he was transferred with from another home. Staff reported that one staff member co-ordinated the admission to the home and that pre admission assessment are not always completed. Staff stated this was partly due to the short notice for admission. Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 9 Information pertaining to the statement of purpose and the service users’ guide are made available on admission. The home also provides respite care to two service users. The service does not provide intermediate care. Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to the service. Some of the care plans were detailed and provided adequate information, however this did not apply to all the care plans seen. Care plans risks assessments and a plan on how the risks would be managed should be further developed in order that all care needs could be met. The health care needs of the service users are well met. The medication management relating to topical creams should be reviewed as this is to the detriment of the service users. The service users are treated with respect and their dignity maintained. EVIDENCE: Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 11 As part of case tracking a sample of 4 service users’ care plans was examined. Some of these were detailed and contained information on how the care needs would be met and included and two of these included manual handling assessments. A service user had been assessed as risk of choking and wandering and risk assessments were in place in the record seen. However not all the care plans seen contained such detailed information. As discussed care plans lacked details such as what type of support is required, when assisting with personal care. One service user needed assistance with a particular aspect of her care. There was no care plan to show how staff supported her with this. Staff reported that there are three service users who were wheelchair bound. There was no manual handling assessments for these service users in the records seen. Another service user record showed that he had three falls in September, no care plan or fall assessment was available. All the service users are registered with a GP and staff reported that they are supported by the local surgery. Staff said that the service users have access to external agency such as district nurses that are available for support in dealing with wound care as required. Wound care plans from district nurses were detailed and provided good information of care given. Continence advice was also available. A sample of Medication Administration Record (MAR) was seen as part of the visit. Records of oral medication as prescribed on the MAR sheet was available. Staff reported that none of the service users were self-medicating at present. Controlled drugs were stored safely. Pain risk assessments were not available, discussed that these should be undertaken as many of the service users due to their mental frailty cannot communicate their pain and would help staff in recognising this. The procedure for administering medication should be reviewed and the registered person must ensure that staff adhere to this for the safety of the service users. During the tour of the premises there were a number of ointments and topical creams found in communal bathrooms. This was brought to the attention of the person in charge and removed as this has the potential of being used as communal and posing infection control risks to the service users. A group of service users spoken with were all very complimentary of the care provided by the home. They stated that staff were very helpful and were treated with respect. Comments included ”the staff are wonderful” and “the girls do their best and I am happy”. Another service user said that “this is a good home and I like living here”. They also said that the staff are always respectful and kind and their privacy and dignity are respected. Comments from the visiting hairdresser confirmed this. Comments received and observation on the day showed that the staff had developed good relationship with the service users and treated them with respect. Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the service. The social and recreational needs of the service users are well managed. Contacts with family are encouraged and supported. Meals are good well balanced and meet with the satisfaction of the service users. EVIDENCE: There is a range of activities that are provided to suit the needs of the service users. The inspector observed that a selection of books were available in the home’s library. Two service users said that they spent a lot of time in the library as it was quiet and they enjoyed the facility. The home has a dedicated activity co-ordinator and the inspector observed a small group of service users playing games. The session was interactive and the service users said that they enjoyed the activities. A service user said that she spent her time making crocheted blankets that she enjoyed. Another service user said that she preferred to remain in her room and staff respected her wishes. Staff reported that activities are undertaken in small groups and sometimes individually. Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 13 The staff reported that church visitors attended the home on a regular basis. A weekly church service is held in the day centre and a few of the service users attended this regularly. Access to the catholic priest is available as required. The views of three visitors were sought on the day of the visit. All of them were complimentary about the care that their relatives were receiving. Comments included “we are very, very happy with mum’s care”. “The staff are very good”. It was evident from interaction observed that staff and the family have developed good relationships and are supportive. The home has an open visiting policy. Records in the visitors’ book and comments from the visitors supported this. There is a planned menu in place that is rotated on a four weekly basis. Meals are taken in dining areas attached to each unit. Lunchtime meal was observed on the day of the visit. Meals appeared well presented, appetising and choices were available. Service users expressed a high degree of satisfaction with the meals provided. Comments from the service users included that the food “was always good” “food excellent and plenty to eat” and that they enjoyed the meals and the choices offered. The service users confirmed that hot and cold drinks and snacks are available at all times and one service user commented, “You only have to ask”. “We do enjoy out cups of tea. Staff said that each unit is equipped with facility for making drinks and this was good. Staff were observed to offer support with meals in a sensitive manner and meals were not rushed. Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the service. The complaint management is good and service users are confident that their complaints would be listened to. Staff have good understanding of adult protection and ongoing training ensures that the service users are protected. EVIDENCE: The home has a complaint procedure in place and the service users spoken with stated that they would approach the staff if they had any concerns. A complaint log was available and record indicated that there has been one complaint that the manager had addressed. The log was detailed and contained records of correspondence to the complainant and resolved with the timescale. It was noted that the complaint procedure did not contain details of the name and address of the commission as required. The service users spoken with were not aware that they could also approach the commission if they wanted to raise any concerns. This was discussed and should be rectified. The home has a copy of the Hampshire County Council ‘Protection of Vulnerable Adults’ policy and procedure and it’s own policy and procedure reflects the guidelines from Hampshire County council’s own policy. Staff spoken with were aware of what constituted abuse and said that they would be Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 15 confident in reporting this to the person in charge. There is an ongoing training programme in the prevention of abuse for staff; four training sessions are planned for the month of October and November 06. Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to the service. The home provides the service users with a comfortable and homely environment. The infection control procedure at the home is poor with offensive odours in some parts of the home. EVIDENCE: A tour of the building was undertaken as part of the visit. Accommodation is provided in a well- maintained, spacious and homely environment with a good complement of communal areas for the service users. Adaptation and equipment were available to maintain and support the service users in maintaining their independence. Service users spoken with said that they liked their rooms. All the bedrooms seen were highly personalised and the service Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 17 users were complimentary about their rooms. The furnishing was of good quality and appropriate to meet the needs of the service users. The décor within the home is good with evidence of on-going maintenance and improvements. The home has well-maintained gardens that are accessible to service users with limited mobility and seating was provided in the garden. It was noted that three of the bedrooms had offensive odours and staff stated that this was a problem and needed further investigation. The provider must ensure that the home is free from offensive odours and that action to rectify this is taken. Staff were observed to follow guidance on infection control, protective equipments such as gloves and aprons were available. Hand washing facilities in the service users rooms were lacking, discussion with staff indicated that that there was no disposable soap or towels available in the service users bedrooms for them to wash their hands following personal care/ incontinence management. There were also no disposable towels in the unit’s kitchen. Staff commented, “We have nowhere to dry our hands”. This poses an infection control risk and needs to be rectified. Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to the service. The staffing level does not meet with the satisfaction of staff and the service users. There is a good recruitment process in place that safeguards the service users. EVIDENCE: The home has a roster for carers and a separate duty roster for ancillary staff. The home is separated in five units and there is one staff member for each unit. Staff reported that each of the units supports between 7 and 11 service users. Discussion with staff and the service users indicated that there is not always sufficient staff in order to meet the needs of the service users. Night duty recently had 2 waking staff and one sleeping staff instead of three waking staff following recent changes. Staff stated that some nights there are three staff including the night co-ordinator who had received no training. Comments from staff included that they “have a high level of stress” and they ”cannot do the job properly”. Issues raised were that “clients are left unsupervised and staff find it “frustrating”. Service users also reported that sometimes staff have to cover two units and “this is not good”. Other issues raised were that the home is “not allowed to cover domestic sickness hours with agency staff”. On the day of the visit the laundry assistant was off sick and there was no additional cover. A carer who came on the afternoon shift went to deal with the Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 19 laundry. Staff reported that there is no laundry assistant on Fridays for the next two weeks due to planned sickness. Staff reported that there is an assistant unit manager on duty and they feel supported by her. They discussed that there are a number of service users due to heir mental frailty needed “a lot of assistance” and that care hours are eroded by domestic tasks. This was discussed with the manager following the visit who stated that staffing levels are being looked at. The registered person is required to ensure that there are adequately trained staff and in sufficient numbers to meet the needs of the service users at all times. This should include domestic staff. It was evident from discussion with the service users that the staff are committed in providing a high level of care. A sample of four staff records was seen as part of the visit. They indicated that all applicants completed an application form and references were obtained including one from the last employer. Appropriate checks such as Criminal Record Bureau (CRB) and POVA checks were undertaken to ensure staff are fit to work at the home. Staff also completed an induction that included manual handling prior to starting work. Staff reported that new staff are provided with terms and conditions of employment following a successful probationary period. Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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): 31,33,38 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the service. The home has a manager responsible for the day-to day running of the service. The health and safety of the service users are promoted. EVIDENCE: The home has a manager who has recently been appointed. Discussion with staff indicated that there are clear lines of accountability within the home. Comments from staff included that the manager was very supportive and had made a lot of positive changes. The manager was not available on the day of the visit. Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 21 The home has an audit system in place and an audit of the short stay service users’ views has started. An audit of long stay service users is planned for October 06. A sample of the servicing records including hoists, fire safety equipments and emergency lighting was seen. This indicated that there is an ongoing programme in place that ensures that the equipments are serviced at regular intervals and ensure the safety of the service users. The home has two administrative assistants who are responsible for records management. All records were maintained securely and there was a good system in place to ensure that records are filed appropriately and easily accessible. Records of weekly fire drills were available. Fire equipments, hoists, lifts and emergency lighting testing/ servicing were carried out in September 06. All substances that are hazardous to health were maintained safely. Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP3 Regulation 14(1) Requirement The registered person must ensure that all service users are assessed prior to admission to ensure that the home can meet their needs. The registered person must ensure that there are detailed care plans in place and including risk assessments to demonstrate how the service users’ needs are to be met. The registered person must ensure that all medication received are handled, stored and recorded appropriately. The registered person must ensure that ensure that the complaint procedure supplied to the service users includes the details of the commission for social care. The registered person must ensure that the home is free from offensive odours. Hand washing facility for staff should be in place to meet with infection control procedures. The registered person must DS0000037250.V314363.R01.S.doc Timescale for action 30/11/06 2. OP7 15(1) 30/11/06 3. OP9 4. OP18 13(2) 17(1) (a) Schedule 3 (k) 22 (7) (a) 30/11/06 30/11/06 5. OP26 12(1) 30/11/06 6. OP27 18(1) (a) 30/11/06 Page 24 Bulmer House Version 5.2 ensure that there are adequately trained staff and in sufficient numbers to meet the needs of the service users at all times. Domestic staff are employed in sufficient numbers to ensure that the home is clean, free from offensive odours. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Bulmer House DS0000037250.V314363.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!