Inspection on 22/02/07 for Bunkers Hill Care Home

This inspection was carried out on 22nd February 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bunkers Hill Care Home 24/10/07

Bunkers Hill Care Home 25/04/06

Bunkers Hill Care Home 20/02/06

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Bunkers Hill Care Home Ross Close off Carlton Boulevard Lincoln Lincolnshire LN2 4WQ Lead Inspector Dawn Podmore Key Unannounced Inspection 22nd February 2007 09:00 X10029.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 Bunkers Hill Care Home DS0000061947.V327455.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 and Care Homes for Adults 18 – 65*. 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. Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bunkers Hill Care Home Address Ross Close off Carlton Boulevard Lincoln Lincolnshire LN2 4WQ 01522 575139 01522 535100 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) None United Health Plc Mrs Caron Lesley Davis Care Home 78 Category(ies) of Dementia (35), Dementia - over 65 years of age registration, with number (35), Old age, not falling within any other of places category (29), Physical disability (14), Physical disability over 65 years of age (9) Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide nursing and personal care for service users of both sexes whose primary needs fall within the following categories:Unit 1 (ground floor) - 15 beds DE over of 55 years of age (to include up to 15 beds DE(E)) Unit 2 (first floor) - 20 beds DE over 55 years of age (to include up to 20 beds DE(E)) Unit 3 (ground floor) - 19 beds DE over 55 years of age Unit 4 (first floor) - 24 beds OP to include 10 OP and 5 PD over 50 years of age. The remaining 9 beds to be registered for PD 18-65 years of age (and to include up to 9 PD/PD(E) 65 years of age and over. People admitted to these PD and PD(E) beds to be accommodated for not more than 12 weeks. The maximum number of service users to be accommodated is 78. Date of last inspection 25th April 2006 Brief Description of the Service: Bunkers Hill Care Home is a purpose built, two storey premises situated on the eastern side of the city of Lincoln. Car parking facilities are available at the front and rear of the building and it is within walking distances of public transport and local shops. The home is located in the centre of a new estate. It has a secure garden at the rear, which includes a patio area; this provides an attractive, safe area for residents to sit in. Accommodation is provided in 4 separate units in 78 single bedrooms, all of which have ensuite facilities. A lift gives access to the first floor. At the time of the inspection the home confirmed that the weekly fees ranged from £380 - £422 depending on the residents assessed needs. Additional charges are made for services such as chiropody, hairdressing and newspapers. Information about these costs as well as the day-to-day operation of the home, including a copy of the last inspection report can be found in the reception area. Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced and took any previous information held by C.S.C.I. about the home into account. The inspection included a site visit, which took place over nine hours with the assistance of a second inspector, Wendy Taylor. The main method of inspection used was called case tracking. This involved selecting a proportion of residents and tracking the care they receive through the checking of records, discussion with them, the care staff, and observation of care practices. A partial tour of the premises was also conducted which included looking at some bedrooms and communal areas. Documentation was sampled, the care records of eight residents were examined and interviews with residents, visitors and staff took place. In the absence of the Registered Manager Ms Jane Crossley the Human Resources Manager and the deputy manager were available throughout the day to assist in the inspection process. Two random inspections have taken place since the last key inspection; these were in November 2006 and January 2007. The outcomes of these inspections are included in this report. On the day of the visit 71 people were living at the home. What the service does well: What has improved since the last inspection? The content of care plans has improved over the last year and further improvements are underway. The activities coordinator has developed a varied programme and is currently using questionnaires to find out more about the residents so that he can provide a more comprehensive programme. Some training has been provided with more planned for the near future and more staff have been given the opportunity to undertake N.V.Q. (National Vocational Qualification) training. Staff are now receiving regular supervision sessions and appraisals to provide them with a support system that enables them to carry out their job more effectively A system has been introduced to gain the views of people who live at the home and those who are involved with the service, such as relatives. This will enable the home to make sure people are happy with the care they receive and Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 6 improve the service it offers. A representative of the company is also recording regular visits to the home and her findings. 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. Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. 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. A satisfactory admission procedure ensures that prospective residents receive an assessment before admission to assure that the home is able to meet their needs. EVIDENCE: Records and peoples comments showed potential residents had received an assessment of their needs prior to their admission. Some staff felt that although the information provided had improved it could be more detailed, so that more comprehensive plan of care could be formulated. In the case of emergency admissions information had been gathered from other sources such as the hospital and social workers. It was recommended that the content of Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 9 the assessments be more detailed so that staff have access to as much information as possible on admission. The home no longer provides intermediate care. Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. 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. Shortfalls in care planning and risk assessment documentation puts residents and staff at risk and could lead to residents care needs not being met, however at the present time health needs are being satisfactorily met. Medications administered by staff are stored, administrated and disposed of safely, however the procedures used regarding self-medication puts residents at risk. Staff respect the wishes and preferences of people living at the home while maintaining their privacy and dignity. Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 11 EVIDENCE: Each resident has an individual plan, which contains information about his or her care needs. Since the last inspection the content of the plans has improved, but further development is needed. For example one assessment said that the resident needed regular eye care, but this was not included in the care plan. The majority of the plans contained good information about the main areas of care, but there were gaps in basic information such as their wishes in connection to meeting religious preferences were not evident. Other information like the life history form also needed consistently completing. These topics had been identified at previous inspections. In one file a letter from social services, following a review of their care package, highlighted 3 areas that needed addressing, one of these had not been added to the care plan. Another regarding the use of shoes rather than slippers when moving the resident was included in the plan, but the resident was wearing slippers on the day of the visit. The resident confirmed that they preferred to wear shoes. Care plans had been reviewed regularly and there was an improvement in the content. Daily entries updating people’s condition had also improved. Residents or their representatives had signed the plans to show that they had been involved in the planning of their care. Although the activities coordinator had maintained good records regarding what stimulation each resident had received most files did not contain a plan to tell staff how residents social needs would be met. One file, for a resident whose assessment stated that she needed to have regular stimulation, had little information to guide staff on how to meet this need. Manual handling risk assessments had taken place, but some forms had sections that were incomplete. For example one resident walked with a frame but that section of the form was blank. At the last random inspection in January staff had identified that a resident was at risk of falling and had fitted bedsides. However there was no assessment to show why these were required. The resident’s next of kin had signed for bedsides to be fitted, but there was no evidence of consultation with the resident, who the social worker felt was able to make an informed decision on the subject. This issue was brought to the attention of the manager. During this visit some of the plans examined contained these assessments, but one plan did not. Other risk assessments, such as for medical conditions and behaviour contained satisfactory information. Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 12 Staff demonstrated a very good understanding of people’s individual needs and preferences. They were seen speaking to them in a respectful, friendly manner and offering choice in their daily lives. Records showed that outside agencies, such as doctors, tissue viability nurse, opticians and chiropodists had visited the home regularly to meet people’s health care needs. Equipment such as hoists, moving aids, and specialist baths are available to meet people’s individual needs. Staff demonstrated a good knowledge of cross infection and appropriate procedures were in place to safeguard people from infection. The home has satisfactory policies and procedures concerning the receipt, storage, administration and disposal of medications. Qualified nurses or senior care staff administer medications using computer generated medication sheets provided by the pharmacist. Records regarding the receipt, administration and disposal of medications had been in the main completed satisfactorily. Several gaps in the signing of administration sheets were noted on one unit so it was recommended that staff be reminded of the need for accurate recording. One resident was administering their own medication, but there was no documentation to demonstrate that they were competent to do so. An appropriate lockable facility had been provided and staff said that her GP and family were happy with the arrangements, but the manager must ensure that the correct assessments take place. Observation and discussions with staff demonstrated that they respected people’s privacy and dignity; they were seen knocking on resident’s bedroom doors, consulting them about their preferences and closing doors when providing personal care. Resident’s spoken with praised the staff and the care they provided. Comments included: ‘the staff look after me well’ and ‘they are very respectful, I can’t complain about anything they do’. Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the 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 good. This judgement has been made using available evidence including a visit to this service. The home offers a varied activities programme that meets the needs of the people who live there. Residents maintain good contact with their families, friends and the local community. Residents’ are offered choice regarding their daily lives. Meals provided offer variety and choice. EVIDENCE: An activities coordinator was appointed last year and he has developed a comprehensive programme of stimulation for residents to take part in. Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 14 Records and discussions with residents, relatives and staff demonstrated that the programme provides varied activities. Residents commented that they enjoyed the activities provided and those who did not wish to take part said that they had been consulted but had declined. Three ladies said that there was plenty to do but they wished that staff would turn the television off as it was left on all day. To address the lack of information in care plans the coordinator has arranged for questionnaires to be sent out to all residents or their relatives. This will help to make sure that he is aware of what people would be interested in doing. A residents meeting is also to be held in March to discuss this issue. Records demonstrated that activities, such as baking, drawing, crafts, musical entertainment, reminiscence therapy, carpet bowls and visits by ‘pat dogs’, had taken place. A hairdresser visits the home weekly and a mobile shop provides sweets, chocolate and toiletries. The coordinator said that a 1940’s day was taking place in March and a barbeque was being arranged for August. Entries in the visitors’ book showed that people have visited regularly. Records, observations and people’s comments showed that residents went out for the day with their families and on outings to local shops. Although records did not identify how religious needs would be met people’s comments showed that the home assisted residents to attend church if they wished to and regular services were held at the home. Residents and staff comments demonstrated that people are given choices at the home. Bedrooms had been personalised and residents confirmed that they had been encouraged to bring small items of furniture, photographs and mementoes into the home. A group of ladies in one of the lounges said ‘we do whatever we want’ and confirmed that they were offered choice in their daily lives. A relative said that her brother would like to do gardening and staff confirmed that this was to be added to the programme when the weather improved. The meals on the day of the visit was nutritionally balanced and well presented. The menu was displayed but it was suggested that a pictorial menu would be beneficial in the dementia units. There have been complaints in the past about the quality of the food but in the main people spoke positively about the menu options. Drinks were freely available in resident’s rooms and staff regularly offered drinks in the lounges. Care staff sat with the residents offering assistance as needed. Resident’s comments included: ‘it’s very good and you get a choice’ and ‘we get lovely food, sometimes too much of it’. One resident said that he had complained about there being too many beans on the menu and that he would like more bacon. Records and comments from the assistant cook showed that changes had been made. She also confirmed that she was undertaking an N.V.Q (National Vocational Qualification) in catering to enhance her knowledge and skills. Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an adequate complaint procedure, but this is not always followed, which means that people are not confident that their concerns will be listened to or taken seriously. Residents are protected by the home’s procedures for handling allegations of adult abuse but not all staff have received adequate training. EVIDENCE: The home has an adequate complaint procedure, which is on display in the reception area and provided to each resident on admission as part of the Service Users Guide. However in the past this has not always been followed, which has led to people raising their concerns with the Commission as well as other agencies, such as social services. Nineteen people have raised concerns about the home with the Commission since the last key inspection in April 2006. Records showed that complaints referred back to the home by the Commission, regarding areas such as food provision and staffing levels, had been investigated and outcomes were recorded. On the day of the visit residents and relatives said that they were overall happy with the care they received however one visitor said that they were Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 16 concerned that their relative was not receiving their eye drops, but records confirmed that these had been administered. The home has satisfactory procedures concerning the protection of vulnerable adults. Since the last inspection social services have conducted four investigations into potential abuse at the home. One of these prompted a random inspection by the Commission. Some issues were substantiated while others were not. One of the main areas of concern highlighted following investigations was the lack of accurate care planning and complaints records. Staff demonstrated a satisfactory knowledge of what to do if they suspected abuse could be occurring but not all of them had received formal training in this subject. The last investigation by social services had been due to staff alerting the manager of their concerns. Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a high standard of accommodation. People living at the home live in a clean, comfortable and homely environment. EVIDENCE: The home is newly built therefore decoration is to a high standard. Each of the 4 units is self-contained with its own kitchenette, bathing facilities and Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 18 communal rooms. A partial tour of the building showed that it was well maintained, clean, tidy and odour free. Bedrooms had been personalised by the residents or their families with photographs, mementoes and small items of furniture. All furnishings were of a good standard. Residents said that they were happy with their bedrooms and the general facilities provided by the home. However some of the complaints received by the Commission in the past year were regarding the cleanliness of some bedrooms. One relative said that the unit sometimes had an unpleasant odour but on the day of the visit no odours were detected. The home has a no smoking policy which people are told about before they come to live at the home. However one relative said that she felt that as residents had to smoke outside a covered area should be provided to keep them dry when it was raining, this concern was passed on to the management team. Separate domestic staff are employed by the home to maintain the cleanliness. Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Minimum staffing levels were being provided, but the high dependency levels on some units means that residents needs are not always met. Procedures for the recruitment of staff were robust and therefore offered protection for people living at the home. The shortfalls in staff training could lead to residents’ needs not being met. EVIDENCE: Staff rota’s and information provided following a complaint to the commission demonstrated that in the main the home was meeting the minimum staffing levels, or operating above those levels. Staff sickness had on occasions meant that on some shifts staff numbers had been below the expected levels, but the manager had informed the Commission when this had occurred. However people’s comments, complaints received, and observations on one of the dementia units, indicated that these levels needed reviewing. Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 20 On some units staff appeared relaxed and unhurried. Staff comments indicated that this was because the agreed minimum staff were on duty that day, which was not always the case. Others felt that more staff were needed to meet the complex needs of some residents on both day and night duty. Comments included: ‘there is not always enough staff on duty, if we have five that’s okay, but we usually loose one to another unit’, ‘we manage with the staff numbers but it’s not ideal’, ‘it’s difficult to do paperwork due to the shortage of admin’ time’ and ‘staffing levels have improved lately’. Some staff also felt that the recent withdrawal of handover time for carers was detrimental, as care staff did not always get to know what was happening on the unit. Residents and relatives praised the level of care staff provided. Comments included, ‘the staff look after me well’, ‘the staff are lovely’, I’m happy with the care, but they could do with more staff’ and ‘usually there are enough staff, but sometimes you have to wait’. Observations on the day of the visit showed that staff were meeting resident’s basic needs. However on the upper dementia unit the activities coordinator had to assist staff when residents needed additional one to one support. Due to the high dependency of the people living on this unit there is a risk of residents not being provided with enough support, especially at mealtimes and when residents exhibit challenging behavior. It is essential that the home consistently provide enough staff to meet people’s needs. Therefore a review of the staffing levels in conjunction with resident’s dependency levels, especially in relation to the units providing dementia care, must be undertaken. The results then need to be shared with the Commission. The home has a recruitment procedure, which included obtaining written references and C.R.B. (Criminal Record Bureau) checks to make sure that potential staff are suitable to care for the people living at the home. The files for six staff, including two who had been recently employed, contained all the necessary documentation to show that the procedure had been followed. Staff spoken to confirmed that they had been recruited in line with this procedure. Records and staff comments showed that new staff had been provided with an induction to the home. They had all undertaken the Mulberry training package used by the home, which consists of watching videos and completing test papers. Complaints received by the Commission, and staff comments on the day of the visit, indicated that some staff felt that this process did not meet their needs. One person said that they had been at the home for several months but had not received ‘proper’ training. The home also needs to make sure that newly qualified nurses have the proper support when they start to work at the home, this should be in line with the Nursing and Midwifery Council guidelines. Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 21 Records and comments showed that not all staff have received essential and specialist training to meet the needs of the residents they care for. The training plan for 2007 showed that the manager had arranged for training in various subjects including: dementia, adult protection, diabetes, infection control and practical care. Staff said that they could not always attend planned training sessions due to staff shortages. Information provided showed that currently 11 staff have an N.V.Q and by March a further 30 will be undertaking the course Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is insufficient leadership, guidance and direction provided to staff to ensure that residents receive a consistent, satisfactory, standard of care. The home has an adequate system in place to gain the views of people about the Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 23 service they receive. Residents’ finances are handled satisfactorily. Staff receive regular supervision. Maintenance and working practices in the home promote the health and safety of residents and staff. EVIDENCE: The home’s manager is a qualified nurse who has over 16 years experience in the care industry. Staff and relatives comments indicated that they felt that the management of the home could be better. Comments from staff and relatives included: ‘ the home is not run effectively, it could be better, we are not respected as people’, ‘I feel that I can talk to the manager and the deputy’, ‘the managements not bad here’ and ‘I have been very well supported by my unit manager and the deputy, but I don’t see much of the manager’. The proprietor has informed the Commission that management support is to be provided from March to support the manager and evaluate where improvements are needed so that residents receive a good standard of care at all times. At the November inspection the home had introduced a system to gain the views of people who use the service. This includes a suggestion box in the reception area and questionnaires. Posters advertising a residents meeting were also seen around the home. Comments from residents and relatives spoken with during the visit indicated that some people were happy with the care provided, however the number of complaints received indicates that others are not. The personal allowance records were checked at an earlier inspection and found to be satisfactory; therefore none were examined during this visit. Records and staff comments demonstrated that staff were receiving regular supervision sessions to support them in carrying out their job. One person did however say that these sessions did not always meet their needs. Annual appraisals had also taken place. The provider or his representitive is required to visit the home monthly and complete a report detailing their findings at the home and how any concerns or issues are to be addressed. At previous inspections these had not been carried out consistently, but records of these visits are now being kept. It was recommended however that the content of the report be expanded to include more detail of how issues at the home were being dealt with and peoples comments. There are a range of policies and procedures available in the home to guide residents and instruct staff, including fire safety. Information collected prior to this inspection demonstrated that the routine maintenance of equipment had been carried out as required. Bunkers Hill Care Home DS0000061947.V327455.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 X 2 X 3 2 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 3 34 X 35 3 36 3 37 3 38 3 Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) 15(2) (b) Requirement The registered persons must ensure that care plans are in sufficient detail to enable care staff to provide comprehensive care. They must include all individual care needs, choices and preferences. The previous timescales were not fully met. Timescale for action 01/05/07 2. OP7 13(4) b & c 15 (1) 3. OP9 13 (2) 4. OP27 18(1)(a) 01/04/07 The registered persons must ensure that all residents have comprehensive risk assessments that identify all risks associated with their care needs and provide management strategies for staff. This must include manual handling and the use of bedsides. The previous timescales were not fully met. The registered persons must 30/03/07 ensure that any residents who administer their own medications are capable of doing so safely. The registered Persons must 01/04/07 review the staffing levels on each unit in conjunction with the dependency levels of people DS0000061947.V327455.R01.S.doc Version 5.2 Page 26 Bunkers Hill Care Home 5. OP30 18 (1) living at the home to ensure that they are adequate to meet the needs of the residents. The registered persons must 01/06/07 ensure that all staff attend training to meet the needs of the people they care for; this must include adult protection, dementia and physical disabilities. The previous timescales were not fully met. 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. Refer to Standard OP3 OP9 Good Practice Recommendations The content of initial assessments should be more detailed so that staff have access to as much information as possible on admission. Staff should be reminded of the importance of correctly completing records relating to the administration of medications. As the home has received numerous complaints the register persons should evaluate why these are occurring and how they can be reduced. The content of the providers report should be expanded to include more detail of how issues at the home are being addressed as well as peoples comments. OP16 OP37 Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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. Bunkers Hill Care Home DS0000061947.V327455.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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