Inspection on 04/12/06 for Bunyan Lodge

This inspection was carried out on 4th December 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 no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bunyan Lodge 04/06/07

Bunyan Lodge 27/11/05

Bunyan Lodge 05/04/05

Bunyan Lodge 19/10/04

Bunyan Lodge 13/05/04

Bunyan Lodge 11/03/04

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

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

CARE HOME ADULTS 18-65 Bunyan Lodge 66/68 Kimbolton Road Bedford Bedfordshire MK40 2NZ Lead Inspector Katrina Derbyshire Unannounced Inspection 4th December 2006 10:15 Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 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 Bunyan Lodge DS0000014994.V321228.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 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. Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bunyan Lodge Address 66/68 Kimbolton Road Bedford Bedfordshire MK40 2NZ 01234 346146 01234 342557 HQ 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) Apex Care Homes Limited Mrs Marilyn Dorling Care Home 15 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (15), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (15) Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th November 2005 Brief Description of the Service: Apex Care Homes LTD owns Bunyan Lodge residential care home. The home provides care to fifteen residents with mental health needs. The accommodation consists of two Victorian semi-detached houses, dining room, office and a kitchen. The basement has a games room, laundry, and storeroom. The home has fifteen single rooms for the residents, which are located on the first and second floors, with shaft lift access. The home has a smoking room for residents who wish to smoke. The rear of the house has an attractive garden and a patio area. The front of the house has a small driveway with limited parking facilities. The home is situated in a residential area close to the town centre with its amenities and good bus and train services. Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of this visit was to undertake a key inspection. This unannounced visit took place on 4th December 2006. The manager Marilyn Dorling was present throughout the inspection alongside an Area Manager and General Manager from the company. During the inspection all communal areas were visited and the inspector spent time with many of the residents’ in the sitting area of the home and dining room. The care of three residents’ was examined by looking at their records and interviewing the residents’ and staff who look after them. The views of residents and other professionals were also received and their feedback has been used alongside information from the home through a pre inspection questionnaire to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit, reporting and strategy meetings. Observations of care practice and communication between the residents’ and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well: All the residents at this home feel that the environment is of a good standard. They like the way the home is furnished and decorated and feel that the home is always kept very clean. One resident said of their individual room “I love it l have everything l need in here all my pictures and my own things”. This means that residents have a pleasant environment in which to live. The way that the home looks after small amounts of monies on behalf of the residents is very good. They make sure that they keep separate records for all the residents and keep receipts for any purchase, this means that residents feel that their money is safe and that the home will manage their finances in their best interests. The home is also very careful when they employ new staff that they make sure that they check where they last worked and carry out another check against a special register that helps them make a decision if that person is suitable to work with vulnerable people. This means that residents can feel safe knowing that the home is cautious about whom they employ in the home and that they do take their responsibilities in the recruitment of staff seriously. Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are several areas that the home needs to improve and change, some examples include: the way they manage medication in the home. A review of the medication system in the home needs to be done as it is not possible to check on the stocks of medication for all residents, as the records kept by the home of medications in the home and received are not always accurate. This would mean that you couldn’t check if a resident had received their medication. Also any returns’ of medication that has not been used has not been recorded. The manager also needs to look at changing certain practices in the home. Residents’ for example are assisted by staff to have their nails cut on a Sunday, two sets of nail clippers are kept in the office; they also all clean their shoes together frequently before the evening meal on a Sunday. This approach does not treat the residents as individuals, and is an out dated approach to caring and supporting residents. All residents also must sign a book for any post that they receive, this again is not needed for everyone living at the home and the manager must ensure residents civil rights are respected at all times. The home has a keypad system for security purposes on the front door. No resident had been given the number to this, so they have to ask staff every time they want to leave the home. The manager at the home must look at this, so resident’s freedom is not restricted in this way. Residents also must be allowed to take risks in their lives. Some residents feel that the manager can at times be controlling. Although they feel that her intention is good and that she has their best interests in mind, they want to be able to make their own choices without feeling that they may disappoint her. The home also needs to look at the subjects that are discussed at residents meetings and what they record in the minutes of these meetings. One resident Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 7 had been named following a recent meeting and it had been discussed and written that their individual room had ‘a dirty smell’ also it had also been written ‘residents have been reminded that rudeness to staff will not be tolerated’. The home must stop these practices; personal information must never be discussed in a group setting or recorded in this way. The tone and approach by staff to residents must also change so that residents are treated with respect and their privacy maintained. 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. Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions to the home are planned and give sufficient information for residents to make an informed choice. EVIDENCE: Examination of care records was undertaken. Of those files seen two residents had lived at the home for several years therefore their assessment information was not able to be fully assessed. However the third care record examined was of a resident recently admitted to the home. The assessment information in place was noted to provide sufficient information, to ascertain if the home would be able to meet the residents’ needs. The individual likes and dislikes of the resident had been detailed alongside the history of the resident and the reason for their admission. It was discussed with the management at the time of this inspection however that entries within this document had been made. These entries should not have been made onto this legal document, as they were not appropriate or relevant to the assessment of the residents needs, they related to the possibility of affecting the homes registration and awaiting results. Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The ethos and systems in place to promote an independent lifestyle for residents is not sufficient to ensure they are able to take risks and make personal choices. EVIDENCE: Care records were examined within the individual files of residents. Care plans were noted to be in place for the assessed needs of the residents. However the information within these plans were not clear in the guidance or direction to staff in how they should meet the needs of the residents. One example was that it was identified that one resident ‘sometimes refuses to have their meals and absconds during mealtimes’, within the plan of action it was stated ‘avoid taking food that makes them sick’. No explanation had been given as to why this may happen or what food items may make the resident feel unwell. A requirement is made that care plans must provide sufficient guidance to ensure all residents receive consistency in the care they receive. Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 11 Other documents seen were also noted to be in need of revision or not appropriate to be used. On one residents file a risk assessment was in place, the template in use had standardised risk factors included so staff could enter if the resident was at risk or not, one of these factors was ‘child abuse’. A revision of these records is required following this inspection. Information received by the Commission for Social Care Inspection through the local Protection of Vulnerable adults scheme showed that two residents at the home wish to be able to take more risks in their lives. Information shows that at times these residents felt and feel restricted by the manager at the home. They made it clear that they believe that the manager’s intention is only to help them, but feel that some of the systems in the home do not allow them freedom of choice. One resident had raised dissatisfaction at not being able to leave the home without asking staffs permission, as they had not been given the number for the keypad lock on the front door. The home had introduced this as they had identified a risk with two other residents that live in the home. However this standardised approach is not acceptable and they must look at this practice in the home so resident’s freedom of movement is no longer restricted in this way. Practices in the home in this area, had also been raised as a concern by a representative of a resident, to the Commission for Social Care Inspection; it was their view that there were “institutional practices” in the home. Within the individual file of a resident who had recently moved into the home a care plan was noted to be in place that was titled ‘adjusting to new environment’. The actions to be taken by staff included ‘ encourage them to follow the daily routines’, ‘encourage then to come down for medication on time’ and ‘encourage them to go for a walk in the evening’. There was no information to show that this resident prior to moving into the home ever went for an evening walk or had ever said that they wanted to, also the routines recorded were that of the home and not reflective of the individual resident. On speaking with this resident they confirmed that they had been “told that they should attend the evening walk but I don’t mind going now”. This residents care review also contained an entry that showed that they were not happy with the restrictions in place concerning the keypad on the front door. The care and support to all residents must be person centred and a requirement is made relating to this. All other comments and feedback from the residents living at the home were positive. All comment cards received only contained positive feedback on the care that they received. This was supported through speaking to residents at the visit to the home. However all residents spoken to confirmed that they were not able to leave the home without a staff member opening the door, therefore their experience of living in the home is different to the views that they gave. Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The home has systems in place to ensure an activity programme is available to residents, however the approach needs to be led by individual need. A review of practices in maintaining the rights and dignity of residents needs to take place, to ensure residents views and rights are recognised and met. EVIDENCE: Photographic evidence was seen on display boards in the home to show that residents had been on an annual holiday in the summer to the Isle of Wight. One resident said of the holiday “ it was just lovely l had a brilliant time”. Other residents spoke of the forthcoming Christmas party and that many of their family members were also attending. Documents were seen and residents confirmed that they attended varying day care resources in which they had opportunities to participate in educational and social activities. However the care plans seen relating to the social and spiritual needs of residents did not Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 13 make clear the individual likes and dislikes of the resident. One plan stated ‘encourage him to participate in activities’, but it did not describe what the resident liked. Another plan for the cultural and faith needs of a resident said ‘ used to attend church service once in a while’. The need for a more individual needs led approach in this area is required. The practice of a walk for many residents each evening at 18.30 needs to be reviewed to reflect a person centred approach. Residents through discussion and written feedback feel that the home have developed good links with the local community on their behalf. Documentary evidence was seen that showed residents used local community facilities including, shops, parks, pictures and pubs. Residents had a good level of knowledge of the resources available to them including advocacy support and transport links. One resident spoke of a personal relationship that they were able to maintain whilst living in the home. They spoke of the importance of this relationship to their overall feeling of well being, and confirmed that the staff at the home supported them in maintaining this. Other residents through discussion also spoke of the staff assisting them in keeping contact with family and friends if they wanted to. They stated that they were able to receive visitors and the staff at the home would make them feel welcome. It was observed that when residents had received any post they were called into the office to collect this, they were then asked to sign a book to show that they had been given it. Through discussion with the General Manager this practice was introduced, as there had been some residents that had previously said they had not received any letters. However this blanket approach to this identified risk is not acceptable. Residents must be allowed to live their lives in a way that does not differ from anyone else and maintains their legal rights and responsibilities. Minutes of resident meetings held in September and November 2006 were read. Entries within the September 2006 minutes made reference to personal and private matters of one resident. In describing their room as having a dirty smell and having this discussed in front of the other residents, the experience of this would have been embarrassing for that resident and their privacy was not maintained. A choice of meals was available, and menus are displayed within the home. All residents said that they enjoyed the meals in the home. On the day of this visit residents had a choice between pizza from a local take away or sandwiches at lunchtime. Several residents had been identified as needing a reduced fat diet however a notice displayed in the kitchen so that anyone could read this must be taken down that states this. A brief observation of the lunch time meal showed it to be unrushed and enjoyed by the residents. Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Aspects of the provision of personal care in this home do not treat the residents as individuals. EVIDENCE: All residents spoken with confirmed that they chose their own clothes and would go into town to the shops when they needed new items; receipts to support this were seen. All residents personal appearance was seen to be clean and their clothing individual. Residents through discussion said that they had their nails cut on a Sunday, there are two boxes each containing two nail clippers in each box that are kept in the office that staff use for this. In addition residents are weighed once a month on a Sunday and clean their shoes together in the dining area of the home. Although no resident complained about this, this practice is not person centred and fails to treat and meet the residents as individuals. The home must review this and a requirement is made. Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 15 Documents within the individual care records of residents demonstrate that healthcare for residents is supported and thoroughly overviewed with residents being enabled to access all relevant services. The staff support residents to receive the full spectrum of healthcare facilities and are conscientious in establishing liaison with all relevant professional bodies who may be able to advise and enhance residents physical health. Health screening is supported and there was evidence that residents are offered informed choice and enabled to refuse screening if they so wish. One resident had reported that they had back pain on the day of this visit, staff immediately arranged for an appointment with their General Practitioner and were arranging transport and to escort them in this. The home had a medication policy, which had recently been revised. On inspection the storage and handling of medication were noted to be carried out appropriately, and the home utilised a monitored dosage system for the administration of medication. However the home did not keep a running balance of the stock of medication in the home for each resident. This is needed as a full audit could not be carried out to ascertain if all residents had received their medication. In addition the home had stopped completing a returns book, this again made it unclear and the home had no evidence of medication disposal. A requirement has been made relating to this. Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Staffs level of understanding in dealing with verbal aggression is not sufficient to ensure residents rights and best interests are met. EVIDENCE: In the two months prior to this visit four referrals had been made under the local Protection of Vulnerable Adults concerning the home. The co ordination of these referrals are on going at the time of this visit and are being managed by Bedfordshire Social services. A joint decision between Health and Social services was made that no placements would be made at the home until the conclusion of their investigation. The home have a Protection of Vulnerable Adults policy and a copy of the local guidance under this scheme. Staff and training records show that they had received training in this subject including types of abuse. Within the minutes of the residents meeting held in November 2006 it had been recorded ‘ residents are reminded that rudeness to staff will not be tolerated’. This does not show that perhaps verbal aggression of a resident is understood and then dealt with appropriately in accordance with Department of Health guidance. A requirement is made relating to this action and was discussed with the management at the time of the inspection. Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 17 Information seen relating to the management of complaints by the home was noted to be satisfactory. The homes complaints policy was clear and set timescales for complainants to receive a response. Resident’s feedback also shows that they are aware of how to complain and to whom. Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of décor, furnishings and fittings in this home are very good creating a pleasant and homely environment for the residents. EVIDENCE: The accommodation to residents was provided over three floors and accessed via a passenger lift. The location and layout of the home was noted to be suitable for its purpose. Furnishings and fittings were domestic and of a very good standard. The communal areas in the home were clean and tidy and residents rooms contained personal items, which reflected their individual personalities. The communal areas of the home were clean and free from offensive odours at the time of inspection as were individual rooms of residents seen by the inspector. Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 19 Policies were in place regarding infection control and staff were seen to be using protective clothing. Hand washing facilities were sited in the areas where waste was being handled. Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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. Staff training has not been effective to ensure that all staff have the needed levels of understanding to provide care in an individual way to residents. EVIDENCE: Staff training records show that staff at the home had undertaken all mandatory training including fire safety and moving and handling. The records supplied by the home show two staff had attended courses in understanding mental health needs in December 2005. The company had also run a further course in March 2006, but records showed no other staff had attended even though some had not undertaken training in this area. All staff should receive this training as they are employed at the home to provide care and support for people with mental health needs. A check of staff files was undertaken to look at recruitment practices. It was noted that the files contained proof of identity, verification of employment history and that Criminal Records Bureau clearance had been obtained. Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 21 Staff through interviewing described the running of the home and how support was given to the residents living at the home. They confirmed that the reason for weighing residents and cutting their nails for example on a Sunday took place, was “because we have more time then, it’s a quiet time”. Staff demonstrated that they did not recognise that this approach was not led by individual resident need, therefore was not appropriate and the restriction of choice that this practice has on residents. Observation of interaction between staff and residents showed that a good amount of conversation took place between them. Residents spoken with felt that most of the staff were supportive to them. Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The leadership and management in the home is not sufficient to ensure care and support to residents is based on current best practice, meeting the individual needs of the residents. EVIDENCE: Written information submitted by the home show that the Registered manager has held her position at the home for 13 years. The manager is a qualified general and mental health nurse and completed her Registered Managers award in 2003. One resident spoken with at this visit said of the manager “l think she is wonderful, l don’t know what l would have done without her”. However information received through the protection of vulnerable adults referrals in the previous two months, raised concerns on her approach at times Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 23 to the care of some residents at the home. The specific concerns raised included residents feeling restricted by not being able to have the combination of the front door lock and her approach to them at times. Feedback received following a discussion with a resident arranged following a strategy meeting was that she could be “parental” at times. The areas of concern raised following this inspection for example the discussion and recording of personal and sensitive information at a residents meeting show that many of the practices at the home are outdated, and do not deliver a person cantered care package to all residents. A requirement is made that the owners of the home in conjunction with the manager embark upon further training to ensure that care delivery in the home is based on current best practice. Health and safety systems at the home were seen to be carried out in accordance with the guidance within the homes policy. The most recent fire and environmental health inspection reports show that the home had met the standards in these areas. Staff wore protective clothing when serving food at lunchtime. In addition cleaning products were seen to be locked away, risk assessments had been undertaken for areas and activities in the home. The home carries out consultation with the residents in different forms. More formal methods such as residents meetings had taken place and minutes were available for inspection. In addition questionnaires had been given to all residents to feedback to the home how they felt about living there. Analysis of this information had also been undertaken, evidence of this was seen. Bunyan Lodge DS0000014994.V321228.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 Adults 18-65 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 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 X 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 1 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 3 2 X 1 X 3 X X 3 X Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 25 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 12 & 15 Requirement Timescale for action 31/01/07 2. YA6 3. YA7 4. YA9 5. YA12 6. YA16 Care plans must contain sufficient guidance and direction to staff in how they should support the resident in meeting their needs. 12, 15 & Care records used for 17 reassessment of risk for residents must not use inappropriate risk factors. 12 & 13 All residents must be enabled to make decisions based on their own personal likes and dislikes, as outlined in their assessment of need. 12, 13, 15 Residents must not be restricted & 17 from leaving the home. Appropriate individual risk assessments should be carried out to ensure resident’s independence is upheld. 12 & 16 The care plans and approach to meeting the social needs of residents’ must be based on each resident’s individual need. A review of the 18.30 walks must take place. 12, 13 & The home must review its 17 approach to upholding the rights of residents living in the home. The practice of having all DS0000014994.V321228.R01.S.doc 31/12/06 31/01/07 31/01/07 31/01/07 31/01/07 Bunyan Lodge Version 5.2 Page 26 7. YA16 8. YA17 9. YA18 10. YA20 11. YA23 12. YA32 13. YA35 14. YA37 residents sign a book for any post must cease. 12 & 13 Management and staff at the home must cease the practice of recording sensitive and personal information within the minutes of residents meetings. 12 & 13 Information relating to residents on a reduced fat diet must not be on display in the kitchen where everyone can read them. In addition information should be recorded on individual records, not collectively. 12, 13 & The personal support that the 15 home collectively provides to residents on a Sunday must cease. All support must be given as and when required so that a person centred approach is followed. 12 & 13 Records must be sufficient of medication in the home to ensure that an audit can be undertaken to ascertain that all medication has been given. 12, 13 & Written records relating to 18 residents must at all times protect their rights as individuals, all verbal communication must also be carried out to safeguard all residents. 12, 13, 18 Training, support and monitoring & 19. must be sufficient to ensure sufficient levels of competency is held by all staff to meet the assessed needs of residents. 12, 13, 18 All staff must receive training in & 19. mental health and meeting the needs of the residents living at the home. 10, 12, 13 The manager must undertake & 18 further training so that care delivery in the home will be based on current best practice. 31/01/07 31/01/07 31/01/07 31/01/07 31/01/07 31/03/07 31/03/07 31/03/07 Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 27 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 YA2 Good Practice Recommendations Information written within the assessment of residents should only reflect the assessment of their needs. Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Bunyan Lodge DS0000014994.V321228.R01.S.doc Version 5.2 Page 29 - 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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