Inspection on 07/04/08 for Bulwer Lytton House

This inspection was carried out on 7th April 2008.

CSCI found this care home to be providing an Adequate service.

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 04/04/07

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 Jane Greaves Unannounced Inspection 7th April 2008 08:50 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.V362050.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.V362050.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 Bulwer@quantumcare.co.uk www.quantumcare.co.uk Quantum Care Limited Mrs Ruby Gladys Holden 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.V362050.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 4th April 2007 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 £486 - £530 per week as at 07/04/2008. Bulwer Lytton House DS0000019301.V362050.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced site visit took place over 6 hours on 7th April 2008. We looked at how the home meets the needs of the people living at Bulwer Lytton House. A partial tour of the premises was undertaken and a selection of care records, staff records, medication records and other documentation were assessed. We spoke to some people living at the home, some staff members and the management team during the course of the visit and some family members subsequent to the site visit. Prior to the site visit the home had completed their Annual Quality Assurance Assessment (AQAA) and forwarded it to the commission. This provided us with information about how the service feels they are performing against the National Minimum Standards, and how they provide positive outcomes for the people living there. Prior to this visit surveys were sent to the home for residents, relatives and staff members to express their views about the service provided at Bulwer Lytton House. Comments from these surveys have been included within this report. What the service does well: Visitors are always made welcome. Relatives felt that staff communicated with them well and kept them up to date with any issues concerning their relative. The interaction seen between staff and residents was very good and there was a pleasant and calm atmosphere in all the bungalows. A relative felt that ‘the rooms and buildings are always beautifully clean and tidy. Carers are supportive and kind.’ One person living at the home said “I recommend that all of you should come here and live with us when youre old”. People living at the home are encouraged to maintain their independence, and have regular opportunities to express their views on the service. People are encouraged to personalise their rooms. Bulwer Lytton House DS0000019301.V362050.R01.S.doc Version 5.2 Page 6 People have access to good information about the home whilst they are making the decision to move in, the website is informative and helpful for prospective residents and families. What has improved since the last inspection? What they could do better: The service provides care workers with training and refresher training in areas including medication administration, safeguarding vulnerable adults and infection control to promote the safety and welfare of the people living at the home. Some staff members have not received training or training updates in these areas, this means that they may not have the skills necessary to keep the people using the service safe. The care plans contained some good information about peoples’ health and social history however there is not enough detail around peoples’ care and support needs to support care workers to provide personalised care. Care workers need to become comfortable using the care plans as working documents on a day-to-day basis. The care plans included documents identifying areas where people living at the home may be at risk such as pressure areas and falls etc. Some of the information was conflicting and did not provide a clear picture of identified risks and the actions care workers needed to take to understand and reduce the level of risk. Bulwer Lytton House DS0000019301.V362050.R01.S.doc Version 5.2 Page 7 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.V362050.R01.S.doc Version 5.2 Page 8 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.V362050.R01.S.doc Version 5.2 Page 9 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): 1, 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clear and comprehensive assessment process assures people that their needs could be met prior to moving into the home. EVIDENCE: The Service has an up to date Statement of Purpose that sets out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the home; and provides a Service Users’ Guide to the home for current and prospective residents. Quantum Care has a web site that provides information about each of their homes including a ‘virtual tour’ of the home and information about activities provided and availability of places. Before a person is admitted into the home, an assessment of their personal care and social and spiritual needs is undertaken. At this point the home explains the type of service they provide and gives the person a brochure of Bulwer Lytton House DS0000019301.V362050.R01.S.doc Version 5.2 Page 10 Bulwer Lytton House. The documentation received from the social worker provides some basic information about the person’s history, needs, likes and dislikes and the individual, together with their family/representatives, are encouraged to provide more detail. The unit manager and the home manager ensure that the prospective resident’s needs may be met before admission and this has been agreed with the person and their family or representatives. Evidence included within the care plans confirmed family input into the assessment process, there was a detailed family history of each person detailing their preferences in areas of daily life. One family member, spoken with subsequent to this visit, confirmed they had been involved with their relative’s admission and assessment along with the social worker and that it had been a collaborative process. Bulwer Lytton has one bungalow that is a dedicated intermediate care unit. This is a eight bedded unit used for rehabilitation for up to a six week period prior to people returning home following a period in hospital. Professional agencies are involved to promote the care of this particular client group. Bulwer Lytton House DS0000019301.V362050.R01.S.doc Version 5.2 Page 11 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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff team are successful in delivering appropriate care, although this may not always be documented appropriately, possibly putting people at risk. EVIDENCE: A plan of care generated from the pre admission assessment of needs is drawn up with each person and provides the basis for the care to be delivered. Four care plans viewed at this visit provided an outline of individuals’ care needs however, there was little detail included to support care staff to provide personalised care. Care staff spoken with demonstrated they knew far more about each person’s personal preferences than could be found in the care plans. Care plans viewed contained dates for reviews although it was not always clear what the outcome of each review had been and if there had been any changes to the plan of care. Daily recording in the care plans was not detailed. It was possible to confirm that someone had got up, had breakfast and watched television however this does not provide enough information about individuals’ demeanour, detail of what or how personal support had been provided or how they spent their day. Bulwer Lytton House DS0000019301.V362050.R01.S.doc Version 5.2 Page 12 There was no evidence to show that care was being provided to meet individuals’ assessed needs. Detailed daily records would help the manager to audit the care being provided, ensure that staff members are following the guidelines and the assessment of needs in the care plans and to provide evidence on which to base the monthly review. The registered manager reported that she was part of a working group within the organisation that was developing a new format for care plans so that information could be recorded in a more person centred manner such as in an essay format including a pen picture to describe what each person’s day was like, what they enjoyed doing and what they did not like so much. Comments received from relatives of people living at the home included “I am very pleased with care and every aspect the staff at Bulwer Lytton offer for X. I think the carers work hard and beyond their call of duty” and “It’s a fabulous place and always clean and fresh. I am really happy with the place; the carers are really focused with what they are doing. Of all the care homes I have seen it is the best.” Each care plan viewed at this visit included records to confirm where GP and hospital appointments had been attended and the outcomes of these. Records of individuals’ weights and body mass index were included within all care plans sampled. Each care plan viewed contained risk assessments relating to areas such as pressure sores, mobility, moving and handling, environment and the risk of people ‘going missing’ from the home. A risk assessment summary was present to provide an overview of each persons’ identified risks however in three of the care plans sampled at this visit the summaries did not reflect the information on the individual assessments. For example, one person was assessed to be at a high risk of falls on the 25/11/07 but the summary of the same date indicated a moderate risk. This person was assessed at being at very high risk of suffering pressure sores however the summary recorded a low risk factor. Another person was identified as being at high risk of pressure sores but the summary recorded no risk element present. This detail was not transferred into the care plans. Relatives of one person where risk had been identified were concerned that there was no plan in place for dealing with the identified behaviour. A discussion was held with the registered manager and it was agreed that the staff team were not aware of the importance of risk assessments. Medication records were checked and were completed satisfactorily, a random physical check of three peoples’ controlled drugs was undertaken and these were recorded appropriately and the balance agreed with the controlled drug register. Medications for all six bungalows were stored in locked cabinets and trolleys within an air-conditioned room. There were two fridges, one containing insulin and was kept locked, the other was for creams and ointments etc. Bulwer Lytton House DS0000019301.V362050.R01.S.doc Version 5.2 Page 13 Records were available to confirm that the temperature of the room and the fridges was regularly monitored. The duty manager reported that staff had received training in the safer administration and storage of medication from the current pharmacy supplier. Records provided subsequent to this visit indicated one of eight Care Team Managers and 24 of 50 care workers had received refresher training in the past 12 months. The home’s training plan for 2008/09 indicated that refresher training was planned for 46 staff members over the next 7 months. The duty manager reported that it is the home’s policy that no person administers medication at Bulwer Lytton House until duty managers have supervised him or her on at least three separate occasions and judged them to be competent. Bulwer Lytton House DS0000019301.V362050.R01.S.doc Version 5.2 Page 14 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be confident that activities and regimes in the home are appropriate for their needs and enable them to live their desired lifestyle. EVIDENCE: Peoples’ social and spiritual interests were recorded and they were provided with opportunities for stimulation through leisure and recreational activities in and outside the home to suit their needs, preferences and capacities. Particular consideration was given to people with dementia and other cognitive impairments, those with visual, hearing or dual sensory impairments and those with physical disabilities. An activities co-ordinator is employed by the service for 30 hours per week. It was reported that many activities take place in each of the six bungalows weekly such as indoor basketball, music and movement, dog therapy, aromatherapy massage, church services, a floristry workshop, reminiscence sessions and line dancing. Plans were reported to obtain a minibus for the home so that people can visit garden centres, zoos, museums, stately gardens and go on shopping trips. A couple of people living at the home enjoy a walk with a carer to the local shops and the pub on occasions. The service has a dedicated activity lounge that includes a bar for residents of all the bungalows to meet for ‘happy hour’ on a Sunday evening. The room has Bulwer Lytton House DS0000019301.V362050.R01.S.doc Version 5.2 Page 15 a photo wall providing evidence of many activities and pastimes that have taken place at the home and a cupboard full of activity equipment such as board games and art and craft equipment. The co-ordinator keeps records of what activities are enjoyed by individuals however these are currently maintained separately from individuals’ care plans. Discussion took place with the activities co-ordinator and the registered manager around how this information could feed into the care plans to help provide an overall picture of peoples’ well being and state of mind. Where people do not wish to participate in group activities the co-ordinator ensures that one to one time is available where individuals can just sit and talk, read the newspaper, have their nails painted or whatever the person wishes to do. It was reported that very often people open up with information they have not shared with other staff members. We discussed how this could be recorded and that activities are not just there for social stimulation but also as a form of therapy and the outcomes need to be recorded in order that it may be included at care plan reviews etc. There was a dedicated hairdressing salon in Bungalow 2 and the hairdresser visits the home fortnightly. Daily routines appeared to be flexible around individuals’ needs and preferences. It was noted that people were able to choose when they wished to get up in the morning. On the day of this visit some people were just getting up and having their breakfast served to them individually at 1100hrs. Some individuals, primarily in the intermediate care unit, were supported to get their own breakfast and teatime meal once they had been assessed by an Occupational Therapist to be safe to do so. The main meal of the day was provided from the central well-equipped kitchen at the home and delivered to each bungalow in a heated trolley. The kitchen was clean and food stocks were generally of good quality. People spoken with were very happy with their lives at Bulwer Lytton House, with comments such as “ it is lovely here, they don’t force you to do things you don’t want to”. Families spoken with reported they were always made welcome at the home and that staff were communicative and friendly towards them. All bedrooms seen were personalised and homely. All people living at the home able to lock own bedroom doors, staff have a master key in case of emergencies. Bulwer Lytton House DS0000019301.V362050.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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People in the home are protected by the practices relating to complaints and safeguarding however records relating to training may not always give individuals this reassurance. EVIDENCE: The service has a clear and accessible complaints procedure that includes the stages and timescales for the process. Records showed that the home recognises complaints as an important tool to ensure they meet the needs of the people living there and that any issues are dealt with promptly and efficiently to the satisfaction to both the people living at the home and their relatives. Feedback from relatives confirmed that they knew how to make a complaint: most stated that they had not needed to make a complaint, but felt able to speak to the manager if they had any concerns; those who had raised concerns had been happy with the way the home had dealt with them. Family members and representatives spoken with as part of this inspection process reported “I am very, very happy that my relative is there, it is a marvellous place, 100 !” and “They always have the residents’ best interests at heart, I am always comfortable talking to the staff/managers, there is good communication” and “they are on the ball whenever there is an issue”. Records provided subsequent to this visit indicated that 37 of the 50 care workers had attended Protection of Vulnerable Adults (PoVA) training during 2007. Eight Care Team Managers were employed to work at Bulwer Lytton Bulwer Lytton House DS0000019301.V362050.R01.S.doc Version 5.2 Page 17 House, records showed that 2 had attended PoVA training in July 2007 but no evidence was available to confirm that the remaining 6 care team managers had received recent training in safeguarding vulnerable adults. At the last inspection there had been no issues relating to staff training in the safeguarding of vulnerable adults. Subsequent to the initial draft report for this inspection site visit the organisation provided us with additional evidence, which suggested that this training had in fact taken place. It is of concern that records in the home did not accurately reflect the true situation. The training plan for 2008/09 indicated that refresher training was planned for 21 staff members in May 2008. Bulwer Lytton House DS0000019301.V362050.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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables people to live in a safe, well-maintained and comfortable environment that encourages independence as far as their capabilities allow. EVIDENCE: A physical tour of premises confirmed the home was clean, comfortable, safe and fresh in all areas and appropriate for the needs and requirements of the people living there. There is an on going programme of decoration and refurbishment and this needs to be continued to avoid some areas of the home appearing dated and tired. The courtyard area has been extensively developed to include a raised seating area, and raised flowerbeds on the lower area. The raised area has easy wheelchair access by ways of ramps and will make an ideal Barbecue space in the summer. The manager reported that wooden table chairs and a parasol Bulwer Lytton House DS0000019301.V362050.R01.S.doc Version 5.2 Page 19 are on order for people to be able to sit and enjoy fresh air in the good weather. Each bungalow now has a dedicated area for wheelchair storage ensuring that bathrooms are no longer used for this purpose. Visitors were able to meet with residents in the communal areas of the home or in their private rooms. Bathrooms and toilets in each house contained the appropriate adaptations required by the residents to promote their safety and independence. The home’s laundry room was suitably equipped with 2 washing machines with sluice wash and hot wash function; hand-washing facilities were available. The service does not routinely provide staff training in the control of infection. A discussion was held with the registered manager around including this within the home’s training programme in order to provide better protection for the people living at Bulwer Lytton House. Bulwer Lytton House DS0000019301.V362050.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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Bulwer Lytton House are supported by a staff team that are appropriately trained and in sufficient numbers to meet their personal and healthcare needs. EVIDENCE: Staff rotas confirmed that the staffing numbers and skill mix of staff are appropriate to meet the assessed needs of the people living at the home, the size, layout and purpose of the home at all times. The manager reported that the staff base has become more stable over the past year resulting in the reduction of the amount of agency staff used at the home. Domestic staff are employed in sufficient numbers to ensure that standards relating to food, meals and nutrition are fully met, and that the home is maintained in a clean, pleasant and hygienic state, free from dirt and unpleasant odours. Feedback from relatives included that some felt there were not always sufficient staff to maintain the recreational needs of the people living at the home however, the recent appointment of the fulltime activities co-ordinator should address this concern. The ratio of staff having achieved a minimum of NVQ level 2 in care has reduced recently due to some established staff leaving the service. Records showed that 24 people working at the home had achieved this qualification. Bulwer Lytton House DS0000019301.V362050.R01.S.doc Version 5.2 Page 21 Four staff recruitment files were looked at and all contained the necessary documents to confirm the right people had been recruited to promote and protect the health, safety and well being of the people living at Bulwer Lytton House, however the registered manager needs to be aware of the need to record and keep evidence on record relating to whether applicants need to provide proof of eligibility to work within the United Kingdom. Feedback from staff included comments such as “I had to wait for my Criminal Record Bureau check to come through before I could start work. My references were also checked. I think this is a good idea” and “I have regular reviews with my line manager and I can discuss anything with her. My line manager will discuss my progress at work and we will talk about what needs changing if any problems arise”. Positive interaction was observed between residents and staff throughout the day. There was a staff training and development programme in place to provide care workers with the skills and knowledge to fulfil the aims of the home and meet the changing needs of people living there, evidence was not available for scrutiny at the visit but was subsequently provided. The records showed many gaps in the training provision, for example medication training, the Protection of Vulnerable Adults and moving and handling. A training plan was provided for 2008/09, this indicated that all areas of shortfall in the training provision would be addressed. Staff surveyed as part of this inspection process reported: “Manual handling, communication, medication, health and safety. These are updated on a regular basis and cover a great deal of how to do your job properly and be a good carer”. Bulwer Lytton House DS0000019301.V362050.R01.S.doc Version 5.2 Page 22 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, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Bulwer Lytton House can be confident that they are at the centre of all plans for improvement and development of the service. EVIDENCE: The registered manager has completed the NVQ 4 qualification and the Registered Manager’s Award. During discussion the manager was able to demonstrate that she has attended relevant training to update her skills such as caring for people living with dementia. The organisation operates a quality assurance system involving the residents, their relatives and other stakeholders. If wished the families may lodge ‘pocket monies’ with the home for residents to purchase daily personal items such as toiletries and newspapers. The funds are maintained in the safe separately with individual records kept Bulwer Lytton House DS0000019301.V362050.R01.S.doc Version 5.2 Page 23 The registered manager undertakes a monthly check of monies held on residents’ behalf. The Manager has developed a care practice-monitoring tool to use at staff supervision. Each carer completes the form prior to their supervision session so that individual areas of practice can be identified and discussed as necessary ensuring that their responsibilities as key worker for the vulnerable people they care for are carried out to the best of their abilities. The manager has recently updated the health and safety policy. The home is subject to a 6 monthly health and safety audit from the organisation. Some areas had been identified for improvement such as levelling some flooring; this work has been scheduled. Wheelchairs and hoists are serviced regularly under contract, Electrical and Gas systems are routinely tested under contract and Portable Appliance Testing is due to take place at the end of this month. A full fire evacuation drill is undertaken twice yearly, the fire panel is checked weekly and it was reported that fire drills take place weekly. It was also reported that fire drills sometimes take place due to burnt toast! During the physical tour of the home some hot water taps were checked at random and were within acceptable temperature ranges. Evidence provided by the organisation following the inspection showed us that records held within the home did not accurately reflect the true position of the training provided for the staff team. Bulwer Lytton House DS0000019301.V362050.R01.S.doc Version 5.2 Page 24 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 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 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 3 X 3 Bulwer Lytton House DS0000019301.V362050.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Care plans must contain clear detail as to what actions care workers need to take to ensure each person’s needs in respect of his/her health and well being are to be met. Timescale for action 30/06/08 2 OP8 13(4)(c) Risk assessments must 30/06/08 accurately reflect the level of risk that people living at the home are subject to so that care staff can take the correct actions to keep people as safe as possible. The person in charge must make sure that care workers receive training to keep people safe. Specifically refers to the safer administration of medicines, the Protection of Vulnerable Adults and the control of infection. 31/07/08 3 OP9 OP30 OP18 18 Bulwer Lytton House DS0000019301.V362050.R01.S.doc Version 5.2 Page 26 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.V362050.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact 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. 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