Inspection on 25/04/06 for Bunkers Hill Care Home

This inspection was carried out on 25th April 2006.

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

The inspector 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 22/02/07

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 Unannounced Inspection 25th April 2006 09:15 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.V291086.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People 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.V291086.R01.S.doc Version 5.1 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) 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.V291086.R01.S.doc Version 5.1 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 OP 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 20th February 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. Limited car parking facilities are available at the front and side 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 with a secure garden at the rear. A patio has been constructed which will provide an attractive, safe area for residents to sit in once the garden has matured and building work around the home has been completed. 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 £379 - £605 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.V291086.R01.S.doc Version 5.1 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 CSCI, about Bunkers Hill Care Home into account. The initial site visit took place over seven hours, this was followed by an additional two and a half hour visit to discuss a recent complaint being investigated by social services. The outcome of that complaint can be found in the body of this report. The main method of inspection used was called case tracking. This involves 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 conducted, documentation examined and the care records of five residents were examined. Interviews with residents, visitors and staff took place; this included the Registered Manager. On the day of the initial visit 60 people were living at the home. What the service does well: What has improved since the last inspection? What they could do better: Although the content of some care plans has improved and further improvements are underway the home needs to ensure that all residents have a comprehensive care plan which tells staff about the level of care and support they require. It must also highlight any potential risks to the resident and/or staff and the strategies in place to minimising these risks. More information is also required regarding people’s individual needs and preferences. An activities coordinator provides social stimulation at the home but people felt that there were insufficient things to do during the day. The manager said that a second person was to be employed to address any shortfalls. The home needs to review the current programme to ensure that it includes appropriate activities for the different people who live at the home. Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 Page 6 Further training and support needs to be provided to make sure that staff have sufficient knowledge to enable them to provide a good standard of care and protection to the residents living at the home. This includes topics such as adult protection, dementia, physical disabilities and palliative care. The home needs to develop a system for gaining the views of people who live at the home and those who are involved with the service, such as relatives, nurses and other professionals. This will enable the home to make sure people are happy with the care they receive and enable them to improve the service it offers. Staff need to receive regular formal supervision sessions to provide them with a support system that enables them to carry out their job more effectively. The Responsible Individual for the Company needs to visit the home monthly and produce a report detailing their findings on how the home is operating on a regular basis. These reports must be available at the home. Three recommendations were also made following this inspection. These were regarding the detail provided in pre admission assessments, the documentation of omitted medications and staff having access to N.V.Q. (National Vocational Qualification) training. 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. Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 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.V291086.R01.S.doc Version 5.1 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 to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are admitted only after a care needs assessment has been carried out. The home has appropriate facilities for providing intermediate care. EVIDENCE: A review of all information available prior to this inspection and evidence seen in residents files and care plans showed that the home does not admit residents without a care assessment being undertaken. Records contained assessments that covered all the main areas of need such as mobility, continence and health conditions. Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 Page 9 As part of the complaint being investigated one resident’s file showed that although an assessment had been completed the content was vague so did not give a total picture of all their needs and abilities. The information received by the home from the social worker was not contained in the their file, therefore it could not be used to formulate a detailed care plan. It was strongly recommended that the person undertaking the assessment ensure that they obtain, and document, all the necessary information regarding potential service users so that staff receive accurate information. Residents, relatives and staff confirmed that assessments had taken place prior to planned admissions. In the case of people admitted for intermediate care the intermediate care team rather than the home carries out the assessments due to the majority of these admissions being urgent placements. The home provides intermediate care on one of the first floor units. The aim of this care is to enable people to rehabilitate after an illness or hospital stay so that they can return to their own homes. The unit provides facilities for people to practice everyday skills such as climbing stairs and making drinks. Staff in the unit have been trained to facilitate rehabilitation, this training was provided by the intermediate care team. This team, which includes doctors, physiotherapist and occupational therapists, visit the unit regularly to provide support. Residents on the unit spoke positively about their experiences. Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 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 to be inspected at least once during a 12 month period 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. A shortfall in care planning and risk assessment documentation puts residents at risk and could lead to residents needs not being fully met. The home is meeting the health care needs of residents. Medications are stored, administrated and disposed of safely, but documentation could be improved. Residents feel that the staff respect their wishes and maintained their privacy and dignity. Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 Page 11 EVIDENCE: A review of all information available prior to this inspection and evidence seen during the two visits to the home showed that although some people had detailed care plans others did not. These plans are important as they tell staff about the care and support a resident’s requires, therefore if they are not comprehensive residents may not be cared for appropriately. The care plans examined on the first day of the visit showed that the in the main the content had improved since the last inspection but more detail was required. This was especially needed with regards to how people prefer to live their day-to-day lives as well any likes and dislikes. Risk assessments had been completed to identify potential risks to residents and staff, these instructed staff on what action needed to be taken to minimise potential risks. Another residents file was examined on the second visit, as part of the complaint investigation undertaken by social services and the Commission. The file did not contain care plans for all of the resident’s needs, there were gaps in the information provided and some information was contradictory. This could lead to their needs not being met or inappropriate care being provided. Risk assessments had been completed but these did not address all potential risks and strategies to minimise possible risks did not contain sufficient information. Plans for people receiving intermediate care were generic therefore did not outline the individual needs of each resident. These need to reflect people’s individual needs and preferences. A form has been introduced since to demonstrate that residents and/or relatives have been involved in planning the care, although all forms were not yet completed staff had started the process. The home is also introducing new care planning documentation which the manager said should address any outstanding issues, a sample of the new documentation was discussed during the visit. At the last inspection it was recommended that a falls assessment be carried out on all residents who have had a number of falls. The manager confirmed that this had not yet been completed but training was taking place in May to educate staff in this subject so that assessments could be undertaken. Monthly care reviews have improved since the last visit; those seen contained better information regarding the effectiveness of the planned care. The home provides appropriate equipment for the management of health care needs, including specialist pressure relieving mattresses. Plans for residents requiring wound care contained adequate information regarding the progress of the wounds including descriptions of the size or grade of the wound and body maps had been used to identify new skin damage. Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 Page 12 Medication practices were seen to be satisfactory. However it was recommended that the form for the documentation of administration of medications be amended to include a section where the codes and reasons for any drug omissions could be recorded. Staff spoken with were aware of residents needs. They were observed caring for people in a considerate, patient and friendly manner. Residents and visitors said that they felt that the staff were meeting people’s needs and were mindful of respecting resident’s privacy and dignity. Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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. Social stimulation is provided by the home but this needs to be improved. Relatives and friends of residents are made welcome in this home. Choice is given in all aspects of the lives of the residents living at the home. Meals provided offer variety and choice. EVIDENCE: A programme of activities has been formulated and the home employs a full time activities coordinator to provide social activities. On the day of the visit she was seen playing scrabble with a resident. Records demonstrated that Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 Page 14 activities such as dominos, quizzes and games had taken place but people said that there was little to do at the home. The manager said that a second person was to be recruited so that more activities could take place. The manager confirmed that the activities person had visited another care home to provide her with new ideas for activities especially for residents with dementia. Comments included ‘I am quite new so I have not been told about any activities yet’, ‘there’s not much to do during the day’, ‘ I go walking outside a bit, I also enjoy knitting’ and ‘there are no organised activities to my knowledge’. A hairdresser visits the home weekly and a mobile shop provides sweets, chocolate and toiletries. Records contained details of people’s religions and a religious service takes place on alternate weeks which residents can take part in if they so wish. Residents and visitors confirmed that the staff made people feels welcome when they visited. People commented, ‘they make me really welcome, I even keep a pair of slippers here’, ‘I am always offered a cup of tea, the staff are very friendly’ and ‘my visitors come regularly in the evening’. Residents and staff outlined how people were offered choice in the home. This included a choice of menu, where they ate their meals, the clothes they wore and times for getting up and going to bed. However as previously stated, documentation regarding people’s preferences was not completed in sufficient detail to make staff aware of individual needs. Meals are prepared in the main kitchen and transported to each unit in a hot trolley. Each unit has its own kitchenette with a hot trolley, microwave and dishwasher. On most units care staff serve the meals which means that they are taken away from their care role. At the last inspection the manager said that she was advertising for separate staff to serve and clear away at mealtimes so that care staff were more available to help people with their meals however this has not yet occurred. Menus are varied and provide a good choice. The menu was displayed in dinning areas to inform people of what was available that day. Lunchtime was observed on the unit providing nursing and intermediate care. It consisted of cottage pie or baked ham followed by apple crumble and custard. The meal was well presented and residents commented that the food provided was very good. Comments included: ‘the food is very nice and you can always ask for more if you want it’ and ‘you can choose what you want, it’s very good food here’. A member of staff said that she ate her meals at the home and felt that the quality was very good. The cook said that alterative meals were provided as required and discussed arrangements for meeting the needs of a resident who is a vegetarian. Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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. The home has satisfactory procedures for handling complaints. Residents are protected by the home’s procedures for handling allegations of adult abuse. EVIDENCE: The home has a complaints procedure, which tells residents and relatives how to make a complaint and how it will be handled. A copy is on display in the reception area and is provided to each resident on admission as part of the Service Users Guide. A review of all information available prior to this inspection and evidence seen during visits to the home demonstrated that some people are not happy with the care being provided by the home while others are. Residents and relatives spoken with during the visit made positive remarks about the home, however there have been several concerns highlighted to the Commission since the home opened in September 2005. With the exception of one complaint currently being investigated by the Primary Care Trust all have been appropriately concluded. The Commission provided questionnaires to the Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 Page 16 home, to gain peoples views regarding the running of the home, prior to this inspection and the previous one, however none have been returned. The home’s adult protection policy is in line with current local guidelines. A relative had contacted social services during this inspection to raise concerns about the care provided to their relative. The issues investigated were discussed with the manager as part of this inspection. The investigation findings concluded that the home needed to improve its documentation and care practices but staff had not been neglectful. Details of the findings of the complaint are included in this report under the relevant section. Training records showed that adult protection training was included in the induction process and further sessions are planned. Staff interviewed demonstrated a good understanding of the types of abuse that may occur and the appropriate actions to take. Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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 communal rooms. Currently extensive building work is still taking place Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 Page 18 around the home but a garden area has been fenced off to provide somewhere for residents to walk and sit in fine weather. A tour of the building showed that the home was being 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 and relatives said that they were happy with bedrooms and the general facilities provided by the home. Separate domestic staff are employed by the home to maintain the cleanliness. Part of the complaint made to social services included the tidiness of the resident’s room and storage of equipment. Although some equipment was being kept in the bedroom the room was found to be clean and tidy. The appropriate storage of aids and other equipment was discussed with the manager. Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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. Minimum staffing levels were being provided however the home could not demonstrate that it had taken residents dependency levels into consideration. 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: A review of all information available prior to this inspection and evidence seen during these visits showed that minimum staffing levels were being met the majority of the time. Staff sickness had however meant that on some shifts staff numbers had been below the expected levels. The home must endeavour to ensure that adequate staff are provided. It was highlighted in the last report that the manager needed to demonstrate that adequate staff was being provided to meet the needs of the residents Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 Page 20 currently living at the home. Although the manager said that dependency levels had been assessed there was no documentation to support this. On the day of the first site visit 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. Comments from residents and visitors indicated that staff provided good care. Comments included, ‘the staff are nice, I’m not sure but maybe more staff are needed they seem very busy’, I am pretty independent, but staff help me get dressed etc’, ‘the staff nurses are brilliant, but there seems to be a lot of new faces’ and ‘I feel relaxed leaving mum here, we are very happy’. It is essential that the home consistently provides enough appropriately experienced staff to meet people’s needs. Therefore a review of the staffing levels in conjunction with residents dependence needs must be undertaken as a matter of urgency. The manager had not completed the data requested regarding this issue on pre inspection forms issued by the Commission at this or the last inspection. 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 four staff, including a recently employed member of staff, 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. Since the last inspection the home has completed inductions on staff employed, this provides essential training and information to help them do their job. Some staff said that they had attended tissue viability training and the manager confirmed that minimising the risk of falls training is planned for May 2006. Staff comments and training records showed that some staff had not received mandatory and specialist training to meet the needs of the people they care for, this includes dementia awareness, physical disabilities and palliative care. Staff must receive appropriate training so that they are able to understand resident’s illnesses and can care for people appropriately. Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. 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 sufficient leadership, guidance and direction to staff to ensure residents receive a satisfactory standard of care. The home does not have a system in place to gain the views of people who use the service. Shortfalls in staff supervision could lead to residents’ needs not being met. Residents’ Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 Page 22 finances are handled satisfactorily. 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 15 years experience in the care industry. Her fitness to manage Bunkers Hill was assessed in 2005 when she was successfully registered with the Commission. Staff, residents and relatives spoken to say that the manager was approachable and listened to any concerns they had. The home does not have a system in place to gain the views of people who use the service. People who had been admitted for intermediate care had completed a questionnaire on discharge, these had been provided by the Primary Care Trust and the information had not been used by the home to evaluate its performance. A residents meeting had taken place on one of the units, but this had not involved everyone living at the home. Comments from residents and relatives spoken with during the visit indicated that on the whole they were happy with the care provided. The personal allowance records of 2 residents were examined and found to be correct, these included receipts for purchases made. Since the last visit entries are now signed by two people to verify that totals are correct to provide added security. The manager has introduced a staff supervision system but records did not demonstrate that all staff had received these sessions. These are needed to provide support for staff to enable them to do their job better. As the home as been open for less than a year annual appraisals have not yet been undertaken. The provider 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. There was no evidence at the home that these visits had taken place since December 2005. There are a range of policies and procedures available in the home to guide residents and instruct including fire safety. A fire risk assessment has also been completed. Care staff receive fire training as part of the homes initial training and equipment is regularly tested. Pre inspection information completed prior to the last visit in February 2006 and sampling of records demonstrated that the routine maintenance of Health and safety equipment had been carried out as required. Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 Page 23 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 2 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 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 3 32 X 33 1 34 X 35 3 36 X 37 2 38 3 Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 Page 24 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&c 13(4) Requirement Timescale for action 01/06/06 2. OP7 15(1) 15(2)b 13(4)b&c 3. OP12 16(2)m&n 4. OP27 18(1)(a) Care plans must be in sufficient detail to enable care staff to provide comprehensive care. They must include all individual care needs, choices and preferences. The previous timescale is still valid. The home has improved the recording systems but further development is required All residents must have 01/06/06 comprehensive risk assessments that identify all risks associated with their care needs and provided management strategies for staff. This must include subjects such as behaviour The previous timescale of 1/4/06 was not met. The home must provide an 01/06/06 appropriate formal programme of activities. This must take into account the different category of service users living at the home. The previous timescale is still valid. The Company must review the 30/05/06 dependency levels of people living at the home along with the DS0000061947.V291086.R01.S.doc Version 5.1 Bunkers Hill Care Home Page 25 5. OP30 18 (1) 6. OP33 24(3) home’s layout to ensure that the staffing levels are adequate to meet the needs of the people living at the home. The previous timescale of 01/04/06 has not been met. Although the manager said that dependency levels had been assessed there was no evidence to support this. All staff must attend mandatory and specialised training to meet the needs of the people they care for; this must include dementia, physical disabilities and palliative care training. All new staff must undergo a comprehensive, documented induction programme. The previous timescale is still valid. Progress has been made regarding staff induction but further training is needed. The home must introduce and maintain an effective quality monitoring system based on seeking the views of residents and visitors. The results of any surveys must be published for their information. Staff must receive regular supervision and appraisal sessions. 01/07/06 01/08/06 7. OP36 18(1 (a)& 2 01/08/06 8. OP37 26(1)(4)(5 Monthly visits must be made by the provider and documented in accordance with Regulation 26 30/05/06 Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 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. 1. Refer to Standard OP3 Good Practice Recommendations It was strongly recommended that the person undertaking initial needs assessments ensure that they obtain, and document, all the necessary information regarding potential service users so that staff receive comprehensive information. The form for the documentation of the administration of medications should be amended to include a section where the codes and reasons for any drug omissions could be recorded. The home should have a minimum ratio of 50 trained staff members to NVQ level two excluding the registered manager. 2. OP9 3. OP28 Bunkers Hill Care Home DS0000061947.V291086.R01.S.doc Version 5.1 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: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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