Inspection on 26/10/05 for Bulwer Lytton House

This inspection was carried out on 26th October 2005.

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

Bulwer Lytton House 07/04/08

Bulwer Lytton House 04/04/07

Bulwer Lytton House 14/02/06

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 26th October 2005 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.V260901.R01.S.doc Version 5.0 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.V260901.R01.S.doc Version 5.0 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 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.V260901.R01.S.doc Version 5.0 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. 22nd February 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.V260901.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. It was disappointing to note that there remained several requirements outstanding from the previous inspection report. Nevertheless, feedback from service users and staff was very positive. Service users spoken to said that they were well looked after and cared for. However, there were areas, which required immediate attention. These included the bath hot water temperature, which was very high to be reduced to a safe level, and the fire safety regulations were breached by the use of door wedges. Issues in relation to the safe administration and management of medicines needed to be addressed. The management must ensure that the National Minimum Standards and its accompanying legislations are complied with and adhered to. 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 health and safety issues and there is a need to provide refresher training for all staff. 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, fire safety regulations and health and safety requirements. She must implement a monitoring and auditing system to ensure that there are no shortfalls within these practices. She must also provide daily recreational activities for service users and promote local, social and community participation. Bulwer Lytton House DS0000019301.V260901.R01.S.doc Version 5.0 Page 6 Staff must be provided with the relevant training and a competence test carried out afterwards to ensure they are safe practitioners. The registered manager must identify and eliminate the lingering strong odour in service user’s bedroom. She must ensure that the requirements of this report is complied with within the given timescale and produce an action plan. 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.V260901.R01.S.doc Version 5.0 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.V260901.R01.S.doc Version 5.0 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): 1-6 All service users have their needs fully assessed 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). EVIDENCE: The home has a written ‘Statement of Purpose and a Service User Guide’ but the ‘Service Users Guide’ was not available to service users in Bungalow 1 which provides intermediate care. Service users and relatives spoken to confirmed that they were encouraged to visit the home prior to admission. There was evidence in the care plans scrutinised 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. 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.V260901.R01.S.doc Version 5.0 Page 9 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 must be reviewed on a regular basis. Shortfalls in the administration and management of medicines were noted. 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, neither these nor the risk assessments were reviewed on a regular basis to reflect the changing needs of service users. It was noted that service users weights were not checked and monitored on a regular basis. Service users in Bungalow 1 received additional and ongoing input from health professionals. Service users spoken to confirmed that their needs were being met. The records of medicines including the administration and management had major shortfalls whereby medicines were not given and there were unexplained gaps in the Medication Administration Record sheets (MAR). Bulwer Lytton House DS0000019301.V260901.R01.S.doc Version 5.0 Page 10 It was also noted that medication could not be reconciled and the amounts were not carried forward. Olanzepine and Respiridone medicines were still being given to service users but there was no letter kept on file by the Service Users’ GP to state why these were drugs of choice. All service users were appropriately dressed and were correctly addressed by staff. The home has a “knock and wait” policy but it was noted that not all staff were adhering to it. All personal and intimate care practices are carried out behind closed doors. Doctors and District Nurses also see service users in the privacy of their own rooms. Bulwer Lytton House DS0000019301.V260901.R01.S.doc Version 5.0 Page 11 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 there were no activities being provided for service users except in bungalow 5 where a ‘quiz’ session was being held. 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.V260901.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16-18 The home has a robust complaints procedure 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 complaint has been received since the last inspection. Bulwer Lytton House DS0000019301.V260901.R01.S.doc Version 5.0 Page 13 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 The home was kept reasonably clean and generally well maintained. Bedrooms were personalised offering a homely, lived in feel. However, there were shortfalls which must be addressed to ensure that the health and safety of service users are not compromised. 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 was poor TV reception in service users bedrooms due to loose aerial (Bungalow 1). There were a number of broken wheelchairs, some with flat tyres and no footrests. It was noted that adequate lighting was not provided in the medication cupboards to ensure the safe administration and recording of medication. Bulwer Lytton House DS0000019301.V260901.R01.S.doc Version 5.0 Page 14 It was also noted that that the bath hot water temperature in Bungalow 1was 59°C and rising. This must be reduced to the safe required level close to 43°C. There was a very strong lingering odour in bedroom 24 of Bungalow 2 which must be identified and eliminated. Bulwer Lytton House DS0000019301.V260901.R01.S.doc Version 5.0 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 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. Staff files inspected had all the required documents by this Standard. Bulwer Lytton House DS0000019301.V260901.R01.S.doc Version 5.0 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): 33,34,35,37,38 The senior staff who have direct involvement, appear to be dedicated to providing a good quality service. The management of service users personal allowances were kept in good order. Particular attention must be paid to fire safety regulations and health and safety requirements. EVIDENCE: Service users and their relatives spoken to commented positively on the good practices and quality of service provision. However, it was noted that doors were wedged open, regular fire drills were not carried out and records of fridge temperature were not kept. It was also noted that a duvet was placed on the floor next to the service user’s bed to protect him from injury when falling, This must be removed when not needed as it poses a risk to staff tripping over. The management of the personal allowances of service users and personal belongings hand over for safe keeping was kept in good order. Bulwer Lytton House DS0000019301.V260901.R01.S.doc Version 5.0 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.V260901.R01.S.doc Version 5.0 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 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 2 3 3 1 1 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 x x 3 3 3 x 3 1 Bulwer Lytton House DS0000019301.V260901.R01.S.doc Version 5.0 Page 19 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 OP1 Regulation 5(2)&(3) Requirement 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 last inspection report) The registered manager must ensure that care plans are reviewed on a regular basis. The registered manager must ensure that risk assessment are reviewed as part of the care plans. The registered manager must ensure that staff sign the MAR sheets to reflect that medication has been administered and that gaps are not left (Outstanding from last inspection report) The registered manager must ensure that medicines are given as prescribed and the reason for any omissions must be recorded. The registered manager must ensure that medication are reconciled and amounts are carried forward correctly. The amount must tally with the MAR DS0000019301.V260901.R01.S.doc Timescale for action 02/12/05 2 3 OP7 OP7 15(2)(b) 14(2)(b) 02/12/05 02/12/05 4 OP9 13(2) 26/10/05 5 OP9 13(2) 26/10/05 6 OP9 13(2) 26/10/05 Bulwer Lytton House Version 5.0 Page 20 7 OP9 13(2) 8 OP12 16(2)(n) 9 OP13 16(2)(m) 10 OP19 23(2)(c) 11 OP22 23(2)(c) 12 OP25 23(2)(p) 13 OP25 13(4)(c) 14 OP26 13(4)(c) Medication Administration Record sheet (Outstanding form last inspection report) The manager must ensure that if Olanzepine and Respiridone are prescribed a letter is kept on file by the Service Users’ GP to state why these are drugs of choice (Outstanding from last inspection report) The registered manager must ensure that service users are consulted about the programme of activities and provide facilities for recreational activities. The registered manager must ensure that service users are consulted about their social interests, and make arrangements to enable them to engage in local, social and community activities. The registered manager must ensure that poor TV reception in service users bedrooms due to loose aerial must are repaired (Bungalow 1) The registered manager must ensure that broken wheelchairs are repaired or replaced. (Bungalow1) The registered manager must ensure that lights are provided in the medication cupboard to ensure the safe administration and recording of medication (Outstanding from last inspection report) The registered manager must ensure that bath hot water temperature which was 59°C and rising in Bungalow 1 is reduce to the safe required level close to 43°C. The registered manager must ensure that the strong odour in bedroom 24 of Bungalow 2 is identified and eliminated. DS0000019301.V260901.R01.S.doc 26/10/05 09/12/05 09/12/05 09/12/05 09/12/05 02/12/05 26/10/05 26/10/05 Bulwer Lytton House Version 5.0 Page 21 15 OP27 18(1)(a) 16 OP38 23(4)(c) (i) 17 OP38 23(4)(e) 18 OP38 13(4)(c) 19 OP38 13(4)(c) The registered manager must ensure that there are adequate numbers of staff rostered on duty to meet the needs of service users. The registered manager must ensure that doors are only held open by means approved by the fire authority and not wedged(Outstanding from last inspection report) The registered manager must ensure that regular fire drills are carried and a list of those present are kept. The registered manager must ensure that duvet placed on the floor to protect service user from injury when falling must be removed when not needed as it poses a risk to staff tripping over. The registered manager must ensure that a daily record of the fridge temperature is kept. 09/12/05 26/10/05 02/12/05 26/12/05 02/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations Weight should be checked on a regular basis. Bulwer Lytton House DS0000019301.V260901.R01.S.doc Version 5.0 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. 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