Inspection on 12/06/07 for Bulmer House

This inspection was carried out on 12th June 2007.

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

Bulmer House 10/10/06

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 Ms Sue Kinch Unannounced Inspection 12th June 2007 09:30 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.V338779.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.V338779.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 Paul Antony Hazzard 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.V338779.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th October 2006 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.V338779.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The evidence used to write this report was gained from a review of the information sent to the Commission for Social Care Inspection (CSCI) since the last visit. This information included an Annual Quality Assurance Assessment (AQAA) and comment cards from one person who lives in the home and three relatives. A site visit to the home was made on 12th June 2007. During this visit the inspector spoke with approximately 15 of the residents, some with relatives, and observed the interactions between residents and staff. The inspector also spoke with the manager and seven members of staff on duty. Some areas of the home were viewed to consider the furnishings and fabric of the building and documents relating to the running of the home were sampled. What the service does well: Good relationships exist between the staff and the people using the service. Some words to describe staff are ‘patient’,’ consistent’, ‘ friendly’ and ‘very good’. The home is organised into five units and staff are regularly allocated to the same areas so people using the service can become familiar with them. Dignity and respect is promoted and the caring approaches extend to good relations with relatives who feel informed and welcomed to the home starting with their involvement in the pre admission process. A range of regular social activities is provided in groups and on a one to one basis. An activities co-ordinator is employed to promote stimulation and interests and during the morning of the visit was introducing a new board game, which some residents were discussing in one of the units. She also plans external trips. Some residents spoke of attending a concert the day before the inspection visit. An activities room is available and people using the service can use this room at any time. Other staff members are increasingly involved in social stimulation and some have recently been trained in aspects of this such as gentle exercise. Choices are offered for meals and are provided taking the changing needs of residents into account. Residents spoke well of the food at the home. An environment in which people using the service are able to express their views and needs has been developed and they said ‘staff listen’,’staff are very good’ and staff said that they felt residents are able to raise issues. Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bulmer House DS0000037250.V338779.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.V338779.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for assessing prospective resident’s needs means that staff are able to meet people’s needs on admission. EVIDENCE: Since the last inspection some admissions have been made to the home and records for two people were viewed. Prospective residents are provided with information and are able to visit Bulmer House. Some relatives described the booklet that they had received and this was in line with information required in a service user guide. All feedback from residents and relatives confirmed that a pre-admission assessment had taken place and that a member of the management team had completed this. They also said that the staff had subsequently been able to provide the right support. A member of staff confirmed that the management provides information before a new person comes into the home. There are records of pre-admission assessments and Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 9 care management assessments obtained before the admission and, initial care plans. There is also evidence of reviews since admission which relatives confirmed had taken place. The home does not provide intermediate care. Bulmer House DS0000037250.V338779.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. 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. The dignity and privacy of people using the service is promoted. People using the service would benefit from a more rigorous system of assessment, risk assessment and detailed care planning to ensure that all staff have access to details about the support needed to meet care and health needs. Medication is regularly provided but attention is still needed to safe storage of creams. EVIDENCE: Observations of interactions between staff and residents were made and friendly communication and support was noted when providing care. All comments received about the staff approaches from people using the service and relatives were positive. Comments were received about dignity and respect being promoted. Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 11 Following the last inspection it was required that there are detailed care plans in place including risk assessments to demonstrate how the needs of people using the services are to be met. All care plans asked for at this inspection were available but at this inspection more information was still needed. Whilst case tracking a sample of five care plans was viewed and considered in light of observations and comments from staff residents and relatives. One person liked to be left alone in the bath and although there was a moving and handling assessment there was no guidance regarding privacy. For another person staff reported a deterioration of health but this was not risk assessed. There were particular risks concerning use of alcohol but there was no risk assessment or clear guidance. There was some information about bathing but the information in the care plan review conflicted with it and the medium risk identified in the moving and handling assessment was not supported by clear guidance. In another care plan full assistance was recorded as needed with bathing but there were no details of what was needed. The personal care record was incomplete in two care plans. In the care plans viewed there was evidence of reviews in the two-month prior to the inspection but not previously. As stated in other sections of this report there were no individual risk assessments explaining why people using the service were at risk in the dining room or of going into the garden from the kitchen area on the ground floor. There was no guidance about how those who did not need to be restricted would gain access independently. In the AQAA the manager said that the home has regular planned doctors visits to ensure that residents health needs are fully met, but also urgent visits on request are available. Records of health monitoring were discussed with a member of staff who said that they are monitored and recorded regularly. Another said that the community nurse was visiting daily to deal with a number of health needs of people living at the home and that there were good relations with the nurses. In the written feedback two relatives said that health needs are usually met and another said always. Health needs were discussed with two residents who said that their health needs were met and a doctor was called if necessary. A conversation was held with a health professional about the home and it was confirmed that a good relationship was held with the home and that staff always act on the advice given. A member of staff explained elements of the medication system that is in use in the home. The process described was in line with accepted procedures. Most medication is stored securely and is administrated by the management staff. Part of the medication round was observed at lunchtime and administration was followed by recording on computerised sheets and where sampled these had been fully completed. Topical creams were not in bathrooms as noted at Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 12 the last inspection but some were noted to be held open in bedrooms. These should also be securely stored. Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,1314,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Choice and decision-making is increasingly promoted in the provision of social and recreational activities and use of the community but people using the service would benefit from restrictions to areas of the home being based on need and risk assessment. People are provided with food that they enjoy. EVIDENCE: Opportunities for stimulation and activity are available in the home and details of what is available are in a document in the lobby of the home. A lot of examples were noted during discussions with people using the service, relatives and staff during the inspection. In a conversation with a small group of residents bingo, entertainment, board games, attending church services, trips out, and music were discussed. One person in this group had been on the trip to a concert in Portsmouth the day before and another had been to church. One relative gave examples of residents’ involvement in gardening. One member of staff and some people using the service spoke about the regular conversations they have and the exercise sessions that they do in a small Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 14 group. The member of staff had also planned some one-one sessions that morning with people who preferred individual support. During the inspection some people were involved in activities with the coordinator and a volunteer in a designated room and the garden. The room is left open so that people can continue activities when the co-ordinator is not there. The co-ordinators role is also to provide equipment and ideas for people to use in the units. Work is taking place to increase use of these resources. A staff member said that a survey of residents’ views has influenced the activities provided. During the visit it was noted that some residents were making use of the hairdressing facilities and the library. There are several different areas of the home that can be used for recreational purposes. As the tour of the home took place it was noted that some people preferred to stay in their rooms but from a conversation with one person and their relatives it was clear that it was that persons’ choice and that they were still at times taking part in activities. Warm friendly approaches to residents and relatives were noted during the visit. Two residents said that staff were good and that they could have a laugh with them. In a unit where staff were discussed with residents and relatives they spoke highly of the care given saying that they were patient, friendly and welcoming. One relative said that they had been pleasantly surprised by the care in the home. Another said that that they could talk about things with the staff and felt that they would be addressed. They felt adequately informed. Another said that the staff are pro-active. One person was aware that there was key worker and was holding a note from one asking for some information. Choice and decision-making is encouraged and there is some evidence of this in the care plans and in practices viewed and discussed. A conversation was held with staff about the changes to serving of food and that staff have been asked by the manager to assist people to serve themselves to increase they control and decision making. In discussion with staff they talked about choices made by residents about where to eat meals and about times to get up. Residents spoke about decisions regarding trips and food. There was also written evidence of some residents being involved in care plans. However, the restrictions referred to in the above section affect choice and decision-making. Comments about the food from residents included: ‘the food is quite good’,’ I like it’, ’it’s lovely here’, and ‘lunch today was perfect’. The food served at lunchtime was discussed with some people in one of the units and those commenting said that they liked it. Some residents spoke of a ‘mess up with dinner’ on the previous day but said that it was very unusual, that everyone joked about it and the staff sorted it out. Some people visiting said that they thought their relative was ‘fussy’ with food but was enjoying it at the home. Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 15 Food is sent to the unit kitchen/diners from the main kitchen. The manager said that he wants to make major improvements to dining areas raising the quality of the service such as in presentation of food. There is a menu in the home offering choice on a daily basis. Staff said that choices are made the day before but people can change their minds on the day. They also said that the food ordered is regularly provided and people using the service agreed. One member of staff talked about a special diet and that this was being provided. The system for recording and reporting concerns about eating was also described. During the inspection at various times it was noted that staff were serving hot and cold drinks and biscuits to people. Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 16 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. The management cultivate an atmosphere in which concerns and complaints can be raised and people using the service feel able to do this and are confident that they will be listened to. Staff are trained to promote the protection of people using the service. EVIDENCE: The manager reported that no recent complaints have been received. A concern was raised during the inspection process regarding the call system, action was being taken to address this and this is referred to in the management and administration section below. The home has a complaints file for logging action taken and a compliments section, which had been contributed to this year. Some of the people using the service said: ‘ I couldn’t say a word against the place’, ‘I’ve never been upset, the staff are very good’ ‘if I want something the staff will get it’ ‘if I did (have a complaint) I’d tell them (staff) they wouldn’t mind’. One relative said that they found the service excellent and pro active. Other said that they raised issues if necessary and it is sorted out but also that staff check to see if everything is all right. They knew how to make a complaint if Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 17 necessary. In the written survey mixed views were received about how well concerns are responded to but most said the response was appropriate and one person said that it was improving. Most people are aware of the complaints procedure and it is prominently displayed at the entrance of the home. Details of CSCI have been included in the information provided in bedrooms with the service user guide. Adult protection training is provided in the home and a list of the most recent staff trained is available. A full up to date list was not available. Staff spoken with were aware of what constituted abuse and of their responsibilities in whistle blowing and reporting to management. Two people using the service were asked how safe they felt and they said they felt quite safe in the home. Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 18 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): 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service have a comfortable and clean environment to live in but will benefit further from the improvements planned to provide a fully automated sluice, a new call bell system and refurbishments to the kitchen/dining room areas. EVIDENCE: A partial tour of the residential part of the building was carried out. This included observation of communal areas including lounges, kitchen /diners, WC’s, bathrooms, the activities room, kitchen and laundry. Various adaptations have been provided. A sample of the single bedrooms on both floors was also viewed. All were clean, pleasantly furnished and satisfactorily decorated. One of the management team is now responsible for the building and plans are in place to provide a more homely environment with a budget provided for this. Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 19 During the course of the visit the environment was discussed with people using the service and relatives who were satisfied with the cleanliness, atmosphere and general facilities. One person said they’ couldn’t think of anything to improve the place’. A relative spoke of visiting at various times unexpectedly and always finding the home clean. People said that their beds were changed regularly and that they did not notice any smells. There is a system for staff to record items for maintenance although more diligence is needed to record things completed so that the manager can monitor progress. There were many items reported in April and May 2007 but no record of completion for several of them. There is evidence that improvements are planned such as the automation of the sluice room which staff confirmed is needed to improve infection control. The manager confirmed that an automated system was to be installed in both sluice rooms by the end of September 2007. He also spoke of plans for a new call bell system as the current one had gradually deteriorated and was not working properly. (This is addressed fully in the management and administration section). Offensive odours noted in three bedrooms at the last inspection were not noted during this visit. One relative commented on a smell on the first floor. A slight smell noted by the inspector on entering one unit had gone later in the day. Staff said they are provided with disposable gloves and aprons and these were seen in use. A lack of disposable towels for staff in the kitchen/dining areas was noted at the last inspection but this has now been provided. In two kitchens viewed it was noted that the worktops were damaged exposing rough wood posing a risk of cross-infection. The manager said that the environmental health officer had noted this in a recent visit, a requirement had been made for this to be addressed and this was being implemented by the end of June 2007. Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. People using the service will benefit from the action taken by the manager to improve the skill mix of the management and care staff by providing all training required. The manager has reviewed the staffing levels but a further review of the deployment of staff at key times will ensure that needs will can be met A good recruitment procedure is available but people using the service will benefit from better recording to demonstrate that all safeguards are in place. EVIDENCE: Following the last inspection visit a requirement was made in the report about staffing levels, following shortages and concerns raised from staff and service users about there not being enough staff. Before this inspection visit mixed views were received about staff levels from three relatives. One comment was that ‘the home always seems to be short staffed’. Another that one member of staff had to ‘cover all three houses at any one time’ although others spoken with during the visit did not raise concerns about staff levels. Mixed views were received from staff about whether they had time to meet needs. One particular concern was raised about meeting the needs of people with higher dependencies in the mornings. Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 21 However the manager has re assessed the staff levels in June 2007 using the residential forum guidance and considering reduced dependency levels and this indicated that there should be 5.33 staff for each day shift. The staff and management however report that 5 care staff (6 at times) and a minimum of one assistant manager are working on each day shift although there are occasional gaps. Rotas reflected this. There is also an activities co-ordinator on duty five days a week between 9 am and 3pm including some weekend working. Staff are organised so that one is allocated to each of the five units, two on the ground floor and three or sometimes four on the first floor but these staff assist each other where necessary. Management staff carry out all medication responsibilities and all residents have the opportunity to join in the activities so numbers of residents in each unit do vary throughout the day. As reported in the above section on Health and Personal care more work is needed to ensure that all needs and risks are assessed and planned to be met and in this process a review of the deployment of staff is also advised. Concerns were also raised about the levels of domestic staff at the last inspection. But the manager said that sufficient domestic staff are in post so that care staff do not need to undertake routine domestic tasks and a manager said that they are provided 7 days a week. Kitchen, cleaning and laundry staff were all on duty during the inspection visit and the home was clean and reported to always be clean by people using the service and relatives. One member of staff said that care staff only need be involved in domestic tasks if problems occurred when domestic staff were not working and that night staff were also involved. Rotas supported this. A sample of the recruitment records were assessed although the new manager has not yet been responsible for employing any new staff in this home. Two sets of records for staff were sampled and there was evidence of preemployment checks having taken place. However, for one person the details available indicated that a reference from a care home previously worked at had not been obtained and there was no explanation for this. The manager agreed to check this out. In addition both people had been employed after a POVA First check and before a full CRB had been completed. Whilst this is acceptable the details of supervisory arrangements were not recorded. However the new manager is aware of the processes required for employment. In the AQAA submitted by the manager it was stated that 53 of staff have been assessed as at the National Vocational level 2 or above and that there is a comprehensive training programme for staff. He recognises that work is needed to evidence this and to ensure that all staff receive training. In conversation with staff during the inspection there was some evidence that they had received training in the past 12 months. However, in the sample of computerised records discussed with the manager there was: no evidence that the large staff group had received fire training in the last 12 months and the manager said there had previously been confusion over it, there was no Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 22 evidence of health and safety training, and some have had refresher training in infection control and manual handling. In two of the three files sampled, for new staff employed over six months ago, there was no evidence of induction and the probationary review procedure had not been fully followed. Work that had been completed was recent reflecting the manager’s point that he had set these processes in motion. There was also little and only recent evidence in the staff files of supervision after the manager provided the management team with guidance in April 2007. Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 23 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 has already taken steps to review management practices in the home however these need to be embedded to ensure quality of care and safety for people who use the service. EVIDENCE: Since the last inspection in October 2006 the previous registered manager has left the home and a new one was appointed in February 2007. He has previously been a registered manager of other homes for several years, has much management experience and knowledge of departmental procedures and is in the process of completing his application for registration. Aware of shortfalls in the existing service the manager has been assessing management and care practices in the home and has distributed new areas of responsibility Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 24 for the assistant managers. One comment received from a relative was that the new manager is more committed and that the care service is getting better. Two residents said they like the managers that they know but didn’t see much of the others. Some staff said that things were improving at the home. There is evidence of systems being improved such as care plan reviewing, supervision and plans for more training on key issues such as fire. In the (AQAA) document required to be submitted to CSCI it was reported by the manager that the home consults with individuals and in meetings and have made changes in for example, food, key workers and activities. There are also plans to introduce questionnaires for long stay residents and their relatives and friends. However, Hampshire County Council has a quality assurance policy and system produced three years ago that the manager was about to implement this in the home. Lack of this tool or an effective alternative being used has meant that some systems such as those mentioned in the above paragraph, have lapsed. The lack of effective quality assurance is evident in consideration of risk assessment. The manager had stated in the AQAA document that the quality of risk assessments needs improvement. During the inspection it was noted that some action has been taken in the home to address risks such as locking kitchen/diners when not in use, locking doors form kitchen/diners to the garden, and using window restrictors. However, apart from the call bell system the rationale is not based on recent documentation and review. Two large files of risk assessments are in the home but documents were dated before and including 2003. From discussions about the call bell system with management and staff, the control measures were not being rigorously implemented. An immediate requirement notice was left to ensure that the temporary call system fully operates and is consistently used. However the system is not safe as the interim system is not a fully effective on call system that ensures that residents can call staff. The manager had reported the problems with the system but had not been given a date of installation of a new one. Since the inspection visit the manager has provided details of action taken. Other areas of health and safety were considered. Service records for equipment were sampled and in place for the hoists, the lift, emergency lights and installation of a new fire alarm system. The gas safety certificate was not available and a check is needed as to when the last check was carried out. Staff training in respect of health and safety matters was discussed with the manager who agreed that the training record contained no evidence of staff health and safety training or recent fire training. The manager said that eight fire training sessions were planned for the end of June as a matter of priority and that training records needed to be updated. He said that all staff have regular moving and handling training. (Training is addressed in more detail in the staffing section.) Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 25 The management are involved in the management of some residents’ personal finances and this is securely held. A sample of the records and cash were checked and were accurate. Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X x 3 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 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 1 Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 27 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) Requirement Timescale for action 12/08/07 2 OP9 13(2) 17(1) (a) Schedule 3 (k) 18(c)(i) 3 OP30 4 OP30 18(c)(i) 5 OP38 23(2)(c) and (n) 6 OP38 23(2)(c) There must be detailed care plans in place including risk assessments to demonstrate how the service users’ health and care needs are to be met. This is a repeated requirement from the inspection of 10/10/06. Creams and lotions must be 12/07/07 stored correctly at all times to protect service users. This is an amended requirement from the inspection of 10/10/06 More staff and management 12/09/07 supervision must be provided to meet the needs of residents consistently. Staff must be provided with 12/09/07 more training such as in induction, fire and health and safety to ensure that they have the range skills to support residents safely. You must ensure that the 14/06/07 temporary call system fully operates and is consistently used by staff. Residents must have a working system to call staff in an emergency. You must ensure that a long12/09/07 DS0000037250.V338779.R01.S.doc Version 5.2 Bulmer House Page 28 and (n) 7 OP38 13 (4) term solution to the call bell system is resolved to ensure that people using the service have a fully operational system to call staff with. You must ensure that all risks in 12/08/07 the home are assessed and monitored to ensure that control measures are affective in keeping people using the service safe. This must include risks in relation to restrictions of movement. 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.V338779.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Bulmer House DS0000037250.V338779.R01.S.doc Version 5.2 Page 30 - 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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