Inspection on 14/02/06 for Bulwer Lytton House

This inspection was carried out on 14th February 2006.

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 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

Bulwer Lytton House 07/04/08

Bulwer Lytton House 04/04/07

Bulwer Lytton House 26/10/05

Bulwer Lytton House 22/02/05

Bulwer Lytton House 20/05/04

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Claremont House

Oak Ridge

Coopers Mill Ltd

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Paradise Lodge

Bilney Hall

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

CARE HOMES FOR OLDER PEOPLE Bulwer Lytton House Lytton Fields Knebworth Hertfordshire SG3 6DW Lead Inspector Bijayraj Ramkhelawon Unannounced Inspection 14th February 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 Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Bulwer Lytton House Address Lytton Fields Knebworth Hertfordshire SG3 6DW 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) 01438 818000 01438 818006 www.quantumcare.co.uk Quantum Care Limited Susan Mary Kent Care Home 56 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (56), Learning disability over 65 years of age of places (56), Old age, not falling within any other category (56), Physical disability over 65 years of age (56) Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home may accommodate one named service user with Dementia under the age of 65. The home must inform the CSCI if the named service user permanently leaves the home for any reason. 26th October 2005 Date of last inspection Brief Description of the Service: Bulwer Lytton House is a purpose built home accommodating up to 56 elderly persons and comprises of six bungalows grouped around a separate administration and reception area. Each bungalow is self-contained and has its own paved sitting out area. The bungalows are linked by covered walkways and one bungalow has been considerably extended to provide sixteen places for mentally frail elders. The administrative centre is also of bungalow construction and contains the reception, offices, laundry and main kitchen. There is also a large activity area that is used for communal functions. Bungalow 1 provides 8 intermediate beds for older people coming from hospital before returning to their own homes and the service works in partnership with staff from Lister Hospital. The home is located in the centre of Knebworth, close to the main line railway station Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. It was encouraging to note that the home has taken positive steps to ensure that the majority of the requirements made in the last inspection were complied with. Despite the absence of the manager, the current staff have done well to maintain and provide ongoing care to the service users. Feedback from service users and staff remained positive. Service users spoken to said that they were well looked after and cared for. However, an immediate requirement was made to ensure that medicines were stored at the required safe temperature level of under 25°C to ensure that they remain effective. Although the home is functioning, it must also ensure that the staffing levels are reviewed and increased accordingly to enable staff to meet the needs of service users. Particular attention must be paid to management of medicines, provision of day care activities and outstanding repair works. The management must be proactive and have systems and processes in place to ensure that there are continuous monitoring, auditing and checking of all operational activities of the home. These must be in line with all the required legislations, own policies and procedures, National Minimum Standards and the Care Home Regulations. What the service does well: What has improved since the last inspection? What they could do better: The registered manager must reinforce the policies and procedures in relation to the management and administration of medicines and the ‘Administration and Control of Medicines in Care Homes’ issued by the Royal Pharmaceutical Society. The home must devise and implement a format for monitoring and auditing of medicines on a regular basis. The home must also provide daily recreational activities for service users and promote local, social and community participation. Service users’ weight must be checked and monitored on a regular basis. Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 6 Health and safety issues in relation to bathroom being used for storage must be stopped. The Commission must be informed of any lengthy absence of the registered manager and particular attention must be paid in ensuring that any documentation relating to individual service users are identified by their names before being filed away. 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. Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 & 6 Service users have their needs assessed prior to admission and procedures in the home ensure that all aspects of their needs are met. However, a copy of the ‘service user’s guide’ must be given to each service user (specifically those in receipt of intermediate care) and inappropriate admissions must be prevented wherever possible by ensuring that the home carries out its own assessment of needs. EVIDENCE: A written ‘Statement of Purpose and a Service User Guide’ is in place but the ‘Service Users Guide’ was still not available to service users in Bungalow 1 which provides intermediate care. In this bungalow, there was evidence in the care plans scrutinised that the liaison nurse had carried out the assessment of needs for service users but there was no written confirmation made by the manager. Staff spoken to said that there have been inappropriate admissions due to simply agreeing with the nurses’ assessments rather than the home verifying for themselves whether they were able to meet the needs of the service users. This could lead to a break down in the placement or in extreme cases the persons needs not being met. Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 9 In the other bungalows it was noted that a senior member of staff had carried out a pre-admission assessment of needs of the service users either in their homes or places of residence. Service users and relatives spoken to confirmed that they were encouraged to visit the home prior to admission. Intermediate Care is provided in Bungalow 1 where service users are admitted for a six-week’s period for rehabilitation. Staff who work in Bungalow 1 receive specialist training from healthcare professionals in conjunction with company training. Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-10 Service users health, personal and social needs were identified, planned for and delivered in an appropriate manner. Care plans were detailed but service users weight must be checked and monitored on a regular basis to ensure their well-being. Major shortfalls in the administration and management of medicines were identified. Staff must ensure that they adhere to the home’s policies and procedures in relation to the administration of medicines. EVIDENCE: Care plans inspected were comprehensive and had all the information required by this Standard including assessment of needs, risk assessments and how the needs of the service users were being met. However, it was noted that service users’ weights were not checked and monitored on a regular basis. Regular monitoring ensures any potential problems are identified and addressed in a timely manner. Service users in Bungalow 1 received additional and ongoing input from health professionals. Service users spoken to confirmed that their needs were being met. Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 11 However, there were major shortfalls in relation to the storage, checking and management of medicines. The temperature in the medicine trolley in bungalow 2 was 32°C. This reading was well beyond the required safe level of not exceeding 25°C as specified in the Royal Pharmaceutical Society Guidelines. There were no records of medicine room temperature kept either to indicate for how long these medicines were exposed to such temperature. Senior staff spoken to said that they used to monitor the temperature in the medicine rooms but this practice was stopped by the Quality Assurance Manager. Failing to keep medication at the recommended temperature may mean that the medications are no longer effective. There were no regular audits of medicines being undertaken and while checking the stock book, it was noted that there was discrepancies in the number of tablets recorded and the number actually kept in the trolley. It was also noted that there was no staff signature list kept in the home. Hand written instructions on the Medicine Administration Sheets (MAR) were still not being signed by the person making the entries. One of the service users who resided in Bungalow 3 spent most of her days sleeping in one of the bedrooms in Bungalow 4. Although that bedroom was vacant at that time, staff confirmed that she did sleep in other service users beds. The management must re assess her needs to ensure that she is suitably placed where her needs can be best met. Service users spoken to said that they were well looked, food was good and that staff were caring. All personal and intimate care practices were carried out behind closed doors. Doctors and District Nurses also see service users in the privacy of their own rooms. Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 The home promotes autonomy and choice. However, it was difficult to establish who was planning and co-ordinating the activities for service users. This is an area where the home must ensure that meaningful activities are provided for each service user. EVIDENCE: On the day of the inspection, again there were no activities being provided for service users. Service users spoken to confirmed that they were not aware of any weekly programme of recreational activities nor there were any arrangements made to enable them to engage in local, social and community activities. The lunch was unhurried with assistance and encouragement given by staff. In general, service users spoken to were complementary of the food provided. Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 A robust complaints procedure is in place of which service users and visitors spoken to were aware. Staff were aware of the policies and procedures in relation to the protection of vulnerable adults. EVIDENCE: A copy of the complaints procedure was available to prospective and current service users. Those spoken to said that they were aware of the complaints procedure but would prefer to speak to a member of staff or the manager if they had any concerns. Staff confirmed that they have received training on Protection of Vulnerable Adults. No complaints have been received since the last inspection. Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 23, 24, & 26 The home was kept reasonably clean and generally well maintained. Bedrooms were personalised offering a homely, lived in feel. However, numerous broken window air vents needed repair and the bathroom in Bungalow 4 must not be used for storage. EVIDENCE: The home is made up of individual self-contained bungalows with an additional large communal activity room in the central bungalow. Intermediate care is provided exclusively in Bungalow 1. Overall, the home meets the required space standards. The extension in Bungalow 4 has ensured that dining arrangements are less cramped and that service users are more comfortable. All rooms were well furnished and equipped with items that meet the individually assessed needs of each service user. However, there were a number of broken window air vents in numerous bedrooms in Bungalow 1. These air vents were blocked with old newspapers and pillowcases to prevent draughts. It was noted that the bathroom in Bungalow 4 was being used to store an old chair, torn cushions and the ladder. Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 15 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): 27-30 The skills and experience of staff is varied. There was an enthusiastic and caring staff team. However, the number of staff in the home was not adequate to ensure that the holistic needs of service users were being met. EVIDENCE: There was not adequate numbers of staff rostered on duty per shift during the day to ensure that the holistic needs of service users were being met. In bungalow 2 & 3 there was only one member of staff on duty and the duty rota showed that this was the norm despite the varying needs of the current group of service users. This showed that the home is being managed by a skeleton staff, which must be reviewed and increased accordingly. On the day of the inspection, in house training was being provided. Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 16 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, 34, 35, 37 & 38 The senior staff who have direct involvement, appear to be dedicated to providing a good quality service. The registered manager has been on longterm absence. Particular attention must be paid to food hygiene. EVIDENCE: Service users and their relatives spoken to commented positively on the good practices and quality of service provision. Despite the absence of the manager, the home is being well managed. However, it was noted that the Commission was not informed of her long-term absence. It was also noted that there were no records of fridge temperature being kept in the bungalows. There were a number of frayed towels in use and stored in the laundry room. Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 17 All statutory records were available for inspection and maintained in accordance with legislation. Records inspected were up-to-date and accurate and were held securely. Staff spoken to were aware that service users can access their records and information held about them in accordance with the Data Protection Act 1998. The home has policies and procedures in place to ensure that the health, safety and welfare of service users and staff are promoted and protected. These records are accessible to all staff. All accidents and injuries are recorded in the accident book and RIDDOR forms have been completed where applicable. The CSCI has been kept informed of all accidents and admissions to hospital. A valid insurance certificate was displayed and this offered cover of no less than £5 million. Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 18 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 1 X 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 1 x x 1 3 3 x 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 3 3 3 x 2 1 Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5(2)&(3) Requirement Timescale for action 07/04/06 2. OP3 14(1)(a) &(d) 3. OP8 12(1)(a) 4. OP8 14(1)(b) The registered manager must ensure that a copy of the ‘service user’s guide’ is given to each service user (specifically those in receipt of intermediate care). (Outstanding from inspection of 22nd February 2005). The registered manager must 07/04/06 ensure that service users are admitted only on the basis of a full assessment undertaken by people trained to do so in order to prevent inappropriate admissions. The registered manager must 31/03/06 ensure that service user’s weight are checked and monitored on a regular basis. The registered manager must 31/03/06 ensure that a copy is received of all assessment carried out including Waterlow scoring charts prior to service users’ being admitted. The registered person must ensure that hand written instructions on MAR sheets are DS0000019301.V283041.R01.S.doc 5. OP9 13(2) 31/03/06 Bulwer Lytton House Version 5.1 Page 20 signed by the person making the entries. 6. OP9 13(2) The registered manager must ensure that medication are reconciled and amounts are carried forward. The amount must tally with the MAR Medication Administration Record sheet (Outstanding from inspection of 22nd February 2005 ). The registered manager must ensure that a staff signature list is devised and kept for staff who administer medication. The registered manager must ensure that regular audits of medicines in the home are undertaken. The registered manager must ensure that the temperature in the medicine trolley do not exceed the required safe level (The temperature was 32°C - immediate requirement made). The registered manager must ensure that temperature of the medicine room are taken and records kept. The registered manager must ensure that service users are consulted about the programme of activities and provide facilities for recreational activities (Outstanding from last inspection of 26.10.05) The registered manager must ensure that the broken window air vents in bungalow 1 are repaired. The registered manager must ensure that bathrooms are not used for storage. The registered manager must DS0000019301.V283041.R01.S.doc 31/03/06 7. OP9 13(2) 07/04/06 8. OP9 13(2) 07/04/06 9 OP9 13(2) 14/02/06 10. OP9 13(2) 31/03/06 11 OP12 16(2)(n) 31/03/06 12 OP19 23(2)(b) 01/05/06 13. 14 OP22&OP3 8 OP27 23(2)(l) 18(1)(a) 31/03/06 07/04/06 Page 21 Bulwer Lytton House Version 5.1 15. OP31 38(1)(b) ensure that there are adequate numbers of staff rostered on duty to meet the needs of service users. The registered manager or provider must ensure that if the registered manager is away for over 28 days, then they must inform CSCI of this absence. The registered manager must ensure that personal record sheets must be identified by the service users’ names. The registered manager must ensure that a daily record of the fridge temperature is kept. The registered manager must ensure that all frayed towels are replaced. 07/04/06 16. OP37 17(1)(a) 31/03/06 17. OP38 13(4)(c) 31/03/06 18. OP38 16(2)(c) 31/03/06 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 Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 Bulwer Lytton House DS0000019301.V283041.R01.S.doc Version 5.1 Page 23 - 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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