Inspection on 04/04/07 for Bulwer Lytton House

This inspection was carried out on 4th April 2007.

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

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

Other inspections for this house

Bulwer Lytton House 07/04/08

Bulwer Lytton House 14/02/06

Bulwer Lytton House 26/10/05

Bulwer Lytton House 22/02/05

Bulwer Lytton House 20/05/04

Similar services:

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 Marian Byrne Unannounced Inspection 3rd April 2007 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.V335424.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. Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 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 - over 65 years of age (56), Learning registration, with number disability over 65 years of age (56), Old age, not of places falling within any other category (56), Physical disability over 65 years of age (56) Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. OP-56, DE(E)-56, LD(E)-56, PD(E)-56 Date of last inspection 19th December 2006 Brief Description of the Service: Bulwer Lytton House is a purpose built home accommodating up to 56 elderly people 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. Most of the bungalows are linked by covered walkways and one bungalow has been considerably extended to provide sixteen places for mentally frail older people. 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 Fees at the home are from £400 - £463 p.w. Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over about seven hours during the day when there were fifty-five people living at the home. We spoke with service users in each of the six bungalows, talked to staff members and had pre- and postinspection discussions with the newly appointed manager. There were few relatives in the home during the inspection, but one spoke well of the care her mother was given in the Intermediate Care unit. Nurses visiting the unit also spoke well of the care staff, although they also mentioned that there had been problems with medication management. Records and care plans were looked at and a tour of each bungalow took place. Service users’ responses showed that they were happy with the care provided by the staff team at the home and spoke highly of the staff - comments included ‘It’s a wonderful place’ and ‘The staff are very helpful’. People on the Intermediate Care unit said that they are helped to regain their daily living skills and independence to prepare them for their return home. What the service does well: What has improved since the last inspection? The requirements set out in the last report have mostly been met: there has been an increase in the number of staff in one bungalow where service users were frail and at risk of falls; the revised care plan format has been adopted and gives more detail about service users’ needs and daily lives; redecoration and refurbishment has taken place and new carpets have been laid in some areas of the home. Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 Page 6 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. Bulwer Lytton House DS0000019301.V335424.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 Bulwer Lytton House DS0000019301.V335424.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, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service user’s care needs are fully assessed to make sure that the home can meet their needs before they are offered a place in the home. Those people who stay in the intermediate care unit are helped to regain their independence and practice their daily living skills to ensure that they are fully prepared to return to their own homes. EVIDENCE: Service users in the Intermediate Care Unit (Bungalow 1) have been discharged from hospital for a stay in the home to enable them to regain their independence before returning to their own homes. Stays in the unit are usually between two and six weeks and there are regular reviews of service users’ progress by the intermediate care team which comprises health care specialists – nurses, physio- and occupational therapist, doctor – who visit the home several times each week to assess whether people are ready to return to their own homes. The home’s care staff encourage independence and help people to gain confidence in preparation for discharge. Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 Page 9 For those people who are making Bulwer Lytton House their long-term home, an assessment is completed by a care manager, followed by a visit to the person in their own home, or hospital, by a team from the home itself, to make sure that the home is able to meet each person’s individual needs. Bulwer Lytton House DS0000019301.V335424.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. Care is provided by staff who treat service users with respect and who encourage independence, particularly in the intermediate care unit. Changes in care plans are not always fully recorded and may result in service users’ needs not being adequately met. Service users’ medication is not always managed as well as it should be which could place them at risk. EVIDENCE: People living in the home have access to the full range of health care services – appointments and consultations are recorded on their personal care plans. The plans looked at during the inspection were mainly fully completed, although again it was seen that changes in care needs were not always being translated onto the care plan for careworkers to follow and guidance was not always being followed, e.g. a care plan says that one service user, who has dementia, ‘must watch their diet’ but there is no indication that this is monitored by care staff; one risk assessment says that a service user’s weight needs to be monitored weekly, but it is only being checked monthly; another Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 Page 11 person recently discharged from hospital needs their night care plan reviewed but this had not happened. Again it was noted that some care plans (and other documents) were not dated. Medication records (including controlled drugs) were checked and were mostly completed satisfactorily, although we were unable to reconcile one person’s medication: the records showed that there was a discrepancy of two tablets. The visiting community nurses in the intermediate care unit were generally happy with the care given to their patients, but said that on several occasions service users’ medication had run out. They also commented that they thought that care staff need to be more aware of the effects of medication, and should clearly ask each person each time if they need tablets marked ‘To be taken as necessary’. These comments were discussed with the manager at the end of the inspection. Service users were happy with the way that they are looked after and confirmed that they feel that their privacy is respected by the staff in the home. Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are offered a varied and nutritious diet and are given a choice of menu. People with dementia are offered few activities specific to their needs, although general group activities and entertainments are organised. EVIDENCE: We spoke with service users in each bungalow and comments from them included that the staff are responsive and helpful and on the intermediate care unit particularly people said that they were encouraged to do things for themselves in preparation for their return home. During a discussion with a small group of people, one person said that the home is ‘a wonderful place – they don’t rush you’; another said that staff are ‘very helpful’. They thought the home was clean and well looked after. One person who had arrived the previous day said that they were made very welcome. The standard of catering in the home is appreciated by service users, all of whom were very happy with the variety of menu offered. Mealtimes are social affairs and are taken in each bungalow in a cosy and homely atmosphere. We watched lunch being served on one bungalow and were particularly impressed with the approach of care staff who were communicative and Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 Page 13 cheerful; one in particular was helping someone to eat their meal and showed patience and understanding. One of the activities organisers has recently left the home and the other shares her time between each of the six bungalows. Although the care staff are expected to spend time with service users, it is clear that recruitment to the vacant post as soon as possible would benefit service users. The manager acknowledged that the level of activities offered is low at present. People spoken with during the inspection were happy with the activities offered, although discussion with staff members showed that there is no specific programme for people with dementia. The manager should consider whether there is adequate provision for this group and whether there is a need for specific training to be offered to staff. It was difficult to trace service users involvement in activities, and a record in individual care plans would be useful to give a picture of people’s daily lives in the home. Service users or their relatives manage their own finances. Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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. Service users can be confident that their concerns will be addressed by the management team and that they will be protected from abuse. EVIDENCE: There have been no complaints received by the home since the last inspection. Service users said that they would speak to a staff member or the manager if they had any concerns and that they felt that they would be dealt with properly. Staff confirmed that they are given training and guidance in adult protection and prevention of abuse and training records support this. Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 Page 15 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, 22, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is kept clean and is in reasonable decorative order. Service users’ rooms and the communal areas are homely and comfortably furnished. EVIDENCE: The home was clean and odour free in all areas. Although some areas still looked a little shabby, there has been some redecoration and the manager confirmed that there is a rolling maintenance programme to make sure that the decoration in each bungalow is reviewed regularly. Several areas have had new carpet laid. The communal areas in each bungalow were bright and cheerful. The small sitting room in one unit has been furnished to resemble what people may have had in their own homes. There was a coal-effect alight in the grate and the three people sitting talking to each other said they enjoyed using the room as it was ‘just like being at home’ Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 Page 16 Service users’ rooms are well kept and reflect their individual preferences with pictures, photographs and small items of furniture which they may have brought from their homes. One bungalow provides care specifically for people with dementia and there are many ways in which the unit could be adapted to assist people with orientation and independence. The manager is advised to carry out a review of the unit to determine what measures can be taken to improve the environment for the people who live there. There were wheelchairs stored in one bathroom and the main door on one of the bungalows banged loudly – both these concerns were reported to the manager at the end of the inspection and she agreed to look into them. An environmental health officer had recently visited the home’s main kitchen and had been satisfied with the findings; the requirement in the report to repair an extractor fan has been met. Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 Page 17 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. Service users can be confident that staff are recruited safely. Training is given, although there is a need to increase the number of staff who hold a qualification. Service users benefit from having a stable staff group who are familiar to them. EVIDENCE: The manager reported that while there were vacancies in the staff team, the home had not had to use any agency staff as bank and regular staff are filling shifts in the home; this clearly benefits service users who prefer staff who are familiar to them. Records show that there is regular training given to the staff group – all mandatory training was completed and in addition the majority of care staff had attended dementia care and medication training. About one third of the care staff team have achieved the National Vocational Qualification (NVQ) Level 2 in Care. Examination of recruitment records showed that while the necessary security checks had been completed and references were in place for the most recent staff, the manager needs to be aware of the need to check and verify the information on application forms and to record whether applicants need to provide proof of eligibility to work in the UK. The manager agreed that the need to recruit a second activity organiser is a priority – a person had been appointed but was unable to take up the post. Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 Page 18 There is training available for activities organisers which would benefit both service users and staff. Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. The safety of both service users and staff is protected by the homes procedures. Although the manager is not yet qualified or registered, people living at the home benefit from a well-managed and committed staff team and are able to have their say about the quality of care in the home. EVIDENCE: The new manager, Ms Ruby Holden, had been in post for only four weeks and is not yet registered with the CSCI. She is currently working towards achieving the NVQ in Care Management and the Registered Managers Award. She had previously held the deputy manager’s post and is therefore familiar with the home and the people who live there. She set out her priorities which include the need to refurbish the home and to improve the garden areas. Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 Page 20 Quantum Care organises an annual survey of service users and relatives, the outcome of which is passed to the home for action to be taken on any issues which are highlighted as needing attention. In addition an annual forum is held, when service users, relatives, friends and any other interested parties are able to give their views and talk to staff. Health and safety checks on equipment and installations are carried out and recorded regularly and records showed that fire drills and training for staff were up to date. We spoke to members of staff during the inspection – support from colleagues and teamwork were identified as strengths and staff benefit from regular supervision. Once again, some service user records seen had no identifying name or were not dated. Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 Page 21 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 3 x x x 3 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x 2 3 Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15 Requirement The manager must ensure that care plans are reviewed and that care staff follow the guidance set out in care plans. The manager must ensure that medication is managed safely and that records are accurately maintained. An adequate supply of service users’ medication must be kept in the home The manager must make arrangements to offer a programme of activities tailored to individual needs, particularly for people with dementia. The manager must ensure that there are sufficient staff to provide social activities for service users. The manager must ensure that personal record sheets are identified by service users’ names. (This has been brought forward from the report of the inspection on 06/09/06) Timescale for action 04/04/07 2 OP9 13(2) 04/04/07 3 OP12 16(2)(m) 31/05/07 4 OP27 18(1)(a) 31/05/07 5 OP37 17(1)(a) 04/04/07 Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 Page 23 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 2 3 4 5 6 Refer to Standard OP12 OP22 OP28 OP29 OP29 OP31 Good Practice Recommendations Individual care plans should show service users involvement in activities. People living on the dementia care unit would benefit from adaptations to their environment to aid orientation and independence. Care staff should be encouraged and assisted to take up NVQs to meet the standard. The manager should ensure that information on application forms for jobs is crosschecked and verified. The manager should ensure that the eligibility of staff to work in the UK is recorded. The manager should complete her NVQ Level 4 and Registered Managers award as soon as possible. Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Bulwer Lytton House DS0000019301.V335424.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!