Inspection on 05/04/05 for Bunyan Lodge

This inspection was carried out on 5th April 2005.

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

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

Other inspections for this house

Bunyan Lodge 04/06/07

Bunyan Lodge 04/12/06

Bunyan Lodge 27/11/05

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 Ansuya Chudasama Announced 05 April 2005 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 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 Stationary 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Bunyan Lodge Address 66/68 Kimbolton Road, Bedford. MK40 2NZ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01234 346146 01234 342557 admin@apexcare.co.uk Apex Care Homes Limited Mrs Marilyn Dorling Care Home 15 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (15) of places Bunyan Lodge Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th October 2004 Brief Description of the Service: Apex Care Homes LTD ownes Bunyan Lodge residential care home. The establishment provides care to fifteen adult service users (male and female) with a mental disorder. The accommodation consists of two Victorian semidetached houses, dining room, office and a kitchen. The basement has a games room, laundry, and storeroom. The home has fifteen single rooms for the service users, which are located on the first and second floors, with shaft lift access. The home has a smoking room for service users who wish to smoke. The rear of the house has attractive lawns, gardens, and a patio area. The front of the house has a driveway with 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 Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over 11 hours. The inspection comprised a tour of some of the communal areas, talking to staff, the manager, the operations manager, a counsellor, and nine service users. Three service users’ files and other records were also examined. What the service does well: What has improved since the last inspection? What they could do better: Bunyan Lodge Version 1.10 Page 6 The organisation must promote service users’ rights by providing appropriate consultation regarding issues that affected their lives. No decisions must be made on behalf of the service users without first consulting them and their representative with the permission from the service user. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bunyan Lodge Version 1.10 Page 7 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 Standards Statutory Requirements Identified During the Inspection Bunyan Lodge Version 1.10 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,4 and 5 The Statement of Purpose provided some useful information for service users and their representatives to help them make an informed choice in the admission procedure. EVIDENCE: The home had a Statement of Purpose, but it still needed to include all the information listed in Schedule 1 of the Care Homes Regulation 2001. The information recorded on staffing was not clear and had not changed since the last inspection. A copy of the service users’ guide and the inspection report were displayed at the front entrance of the home. The home had not admitted any new service users since the last inspection. The manager informed the inspector that the needs assessments form had been improved to include all the information stated in the standard. Service users’ files inspected contained an information pack called “Welcome to Apex care homes LTD”. Most of the information recorded was for a nursing care home, and it was not individualised to this residential care home. The service users spoken to stated that they had visited the home on an introductory basis prior to making a decision to move into the home. There was also evidence in the files to show that the manager had devised a four day induction programme for service users to get to know the staff, other service users, the local shops and other resources in the community. Three service users’ files inspected had contracts, which were signed by them, the manager Bunyan Lodge Version 1.10 Page 9 and the advocate. It was explained to the inspector that the home’s advocate visited the service users after admission to explain the content of the contract prior to their signing this document. The service user’s contract examined stated that “following agreement with Bedfordshire Health Authority each resident will be required to contribute £5.00 each week towards the cost of the Bunyan Lodge minibus”. There was no copy of the agreement in the home. Bunyan Lodge Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9, Service users were involved in drawing up their care plans. They were empowered to make decisions about their lives with support from staff. Service users were not consulted by head office to help them manage their own finances with support from staff. EVIDENCE: Service users files inspected showed that they all had care plans, and these had been drawn up and signed and dated by them. Restrictions on service users needed to be included in the care plan. However, this information was available in other documents. Service users spoken to stated that they were aware of their care plans. Where service users had refused to sign their plans, this was also documented. A monthly rating chart was completed on all service users. This gave an account of how the service users were progressing, and the information was used in the care plan review. The plans were reviewed on a three-monthly basis. The key worker and the manager prepared a three-monthly progress report on each individual service user for the Health Authority. Service users were also offered a copy of the report. The reports were very detailed. Risk assessments on service users were available but needed to include hazards and a review date. Bunyan Lodge Version 1.10 Page 11 One service user’s file inspected contained no information about his finances in his financial file. The service user was not aware of what finances he had, or how his finances were being managed by head office. The file also showed that this information was not available when the service user was admitted to the home in October, 2004. Another service user’s financial file inspected showed that the statements were not detailed and last statement received was for January, 2005. Some of the service users informed the inspector that they they wanted to deal with their own finances with support from staff. This issue was also raised in the residents’ meeting. There was no evidence to show that the organisation had consulted the service users to find out how they wanted to manage their finances. A requirement had been issued in the previous inspection reports to devolve service users’ money from head office but this had not been complied with. An immediate requirement was issued to the organisation to devolve service users’ finances from head office so they could take control over their financial affairs with support from staff. Service users spoken to informed the inspector that they were able to advocate for themselves, and they were able to access the advocacy services from the day resource centre when required. It was also stated that the staff empowered them to make decisions about their lives. Bunyan Lodge Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16,17. Service users were given opportunities to participate in the day-to-day running of the home and they participated in the local community. Service users were offered healthy meals with choices at all times. EVIDENCE: Service users spoken to stated that they participated in the home’s domestic chores, and some helped with meal preparation with supervision from staff. Regular residents’ meetings were held, and these were well-recorded. Service users also got involved in the selection of staff by talking to them and giving their opinions. Three service users’ records seen showed that they attended therapeutic day care services to build their confidence and develop their skills to become more independent. An activities list also showed what the service user did for the week. Service users attended a befrienders social group, and outings of their choice with staff in the mini-bus. They also went out to the local shops, and some of the service users had joined the gym. The indoor activities included listening to music, playing darts, cards, board games, and bingo. One of the service users played the piano after his meal and other service users welcomed this. The service users also helped with gardening, and barbeques held at the home in the summer months. Bunyan Lodge Version 1.10 Page 13 The service users informed the inspector that they enjoyed going on holiday to the Isle of Wight. They also stated that they felt refreshed after having this holiday. However they were informed in their meeting that the organisation had suggested holidays that were not of their choice. They had involved an advocate and a counsellor to help them deal with this issue. Service users paid for their holidays and outings. The service users spoken to stated that the food at the home was excellent and they always had two choices. This was confirmed on the day of the inspection when the inspector had the evening meal with the service users. The meal was eaten in a relaxed and happy atmosphere. None of the service users were on any special diets and those service users’ files inspected showed that an effort to meet their nutritional needs had been undertaken. The seat that the inspector sat in belonged to a service user who was in hospital. However, service users were observed struggling to get through the gap where the inspector was sitting to take their plates to the kitchen. One service user was observed sitting on his own on a small table near the kitchen entrance. The service user had his back to the other service users. This was because there was no room for the service user to sit with the other service users. The inspector observed other service users empty their food from their plates into a container on the same table, whilst the service user was eating his meal. The service user’s dignity and privacy were not maintained. Bunyan Lodge Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 and 21. The health needs of service users are well met with evidence of good multidisciplinary working taking place on a regular basis. EVIDENCE: Service user files inspected showed that they were all able to get washed and dressed by themselves. The care plans seen showed that where service users needed prompts about their personal hygiene, this was recorded. The manager stated that staff did this in a sensitive manner. Service users had two separate folders, one was for the appointments records and the other folder had information about visits from health care professionals. This was well recorded. The home also had three-monthly care reviews and invited all the professionals involved with the service user. It was noted that the home had good working relationships with health professionals. Service users also had three-monthly medication reviews. The manager stated that all the service users in the home were in good health. This was confirmed by talking to service users who stated that they were well looked after by the staff and they undertook regular exercises. Bunyan Lodge Version 1.10 Page 15 The manager had discussed with service users regarding burial arrangements. The service users had written down their wishes and this information was kept in their files. None of the service users in the home self-medicated. Qualified staff administered medications. The medication sheet seen was completed satisfactorily. Bunyan Lodge Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 The home had a satisfactory complaints procedure, and staff had an understanding of Adult Protection issues. EVIDENCE: Service users’ comments received for all the service users stated that they would speak to the manager, key worker or the advocate if they were unhappy with their care. Evidence also showed that the service users were very good at speaking up for themselves. A complaints procedure was displayed on the notice board. Service users were also given a copy of the complaints procedure, and this was discussed with them in their meetings. One complaint had been received from the service users regarding concerns about their holidays. This was being dealt by the manager and the advocate was also involved. Bunyan Lodge Version 1.10 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,28,29, 30 The home was well maintained; however, the dining room and lounge area did not meet the needs of the service users. EVIDENCE: The home was clean, and described by service users as having a homely atmosphere. One service user stated that she could not wait to go home after she had finished her activities. The home was well maintained with the help of a handyman who worked five days a week. Service users spoken to stated that they liked their rooms, and they were able to bring in their personal belongings to make their rooms homely. The ground floor had the dining room and lounge. Observations at meal times showed that the dinning room was not big enough to meet the needs of all the service users. See standard on lifestyles. The home had a smoking room on the first floor, and in the basement a snooker room. There was also a pleasant garden at the rear of the house. Bunyan Lodge Version 1.10 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36 Service users were supported by competent staff; however, the ratio of staff to service users was not being met. EVIDENCE: The staff files randomly inspected showed that the staff were given job descriptions, and this was confirmed by talking to them. They also stated that they had completed the home’s and TOPPS induction training. A training and development plan for staff was seen. A copy of the training programme for the year was displayed on the wall. Records showed that staff received supervision on a regular basis, and a supervision contract was also signed and dated by all parties. The staff spoken to stated that the manager was very supportive and provided good training. The staff were observed listening and communicating well with service users. The service users stated that they liked the staff, and the cook provided very good meals. The two staff files inspected belonged to qualified nurses with student visas. They had cancelled their training to undertake their NVQ level 3 in January, 2005. This was because they had been offered adaptation training by APEX organisation, and they stated that they were due to start in April, 2005. The staff spoken to had not received a letter from the organisation to confirm that they had been offered this training. The staff contract stated that the staff were to work 20 hours during term times and 35 hours during holiday period due to having a student visa. However, the rota inspected showed that the staff were working Bunyan Lodge Version 1.10 Page 19 very long hours. The home was registered as a residential care home, but the rota and the Statement of Purpose stated that the home employed registered nurses. The staff rota inspected showed that there were gaps when the ratio of one staff to six service users was not met. The service users’ meetings reports inspected stated that service users were asked to stay longer at the resource centre because there were insufficient numbers of staff on duty. The staff team did not reflect the gender and cultural composition of service users. Bunyan Lodge Version 1.10 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 40, 42 The home was managed to a high standard. the home were well managed. EVIDENCE: The manager was a qualified nurse and had many years’ experience working with different service user groups in a variety of settings. Over the years she had undertaken and taught many courses to update her skills and those of the staff. The staff and service users spoken to stated that the manager had an open and very positive approach. This was observed on the day of the inspection when the service users were observed coming to the office to inform the manager what they had done. One service user made a pizza and a thank you card for the manager. She stated that she was given a good birthday at the home but she missed her daughter as she was not able to come. The manager got her daughter to bring her flowers. She and her family were touched by this gesture. Some service users visited the inspector to inform The health and safety aspects of Bunyan Lodge Version 1.10 Page 21 her of how staff and manager had improved their lives since living at the home. The operations manager also stated that the manager was very good. The home had undertaken a stakeholders survey and the questionnaires were given to staff, service users, and families. As explained at the inspection, service users, staff and families were not stakeholders. The results from the questionnaires were displayed on the office wall in the format using pie charts. However these formats were difficult to understand and did not give an analysis on the questions asked. The Operations manager recently undertook a quality assurance audit. The home had an annual development plan and business plan. Regulation 26 visits were undertaken regularly and the manager was able to demonstrate year on year development for each service user, linked to implementation of the individual plan. Records inspected showed that the manager and staff carried out health and safety checks on a regular basis. The service users were also involved and this issue was also discussed in their meetings. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Bunyan Lodge Score 2 3 x 3 2 Standard No 22 23 ENVIRONMENT Score 3 3 Standard No Version 1.10 Score Page 22 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 2 3 2 x Score 24 25 26 27 28 29 30 STAFFING x 3 3 x 2 N/A 3 Standard No 11 12 13 14 15 16 17 3 3 3 2 3 3 2 Standard No 31 32 33 34 35 36 Score 3 3 2 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 3 Standard No 37 38 39 40 41 42 43 Score 4 4 3 3 x 3 x Bunyan Lodge Version 1.10 Page 23 yes 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 1 Regulation 4,18 Requirement The statement of purpose must cover all the items specified in Schedule 1 of the Care Home Regulation 4. The information provided on staffing in the Statement of Purpose and staff rota must be clear and accurate. Time scale of the 31/12/2004 not met Service users must be consulted about their social interests, including where they want to go on holidays. The registered person must ensure that the results from the service users’ questionnaires are made available in a format that is easy for them to understand. Time scale of the 31/12/2004 not met Staffing levels must meet the ratio of one staff (to the highest whole number) to six service users at all times. Time scale of the 31/12/2004 not met The registered person must ensure that the service users’ finances are devolved from head office to the home. Time scale of the 31/12/2004 not met. An immediate requirement was Version 1.10 Timescale for action 31/6/2005 2. 16 5 31/6/2005 3. 39 24 31/6/2005 4. 33 18 31/6/2005 5. 7 20 Action plan to be provided by 14th April 2005. Bunyan Lodge Page 24 issued 6. 34 18 The registered person must provide a policy and procedure relating to the recruiting of staff that makes the procedures entirely clear and transparent, particularly where they overlap with other procedures such as those relating to the recruitment of adaptation nurses for training. Not inspected on this ocassion. The home must ensure that staff with student visas do not exceed their working hours. The home must provide evidence of visa conditions of employment Provide the CSCI a copy of the agreement with Bedfordshire Health Authority where each service user had been required to contribute £5.00 per week to the cost of the homes mini bus. Service users must be consulted at all times about any issues that involve them. No decision must be made by the home without the agreement from the service users. Their representatives must also be involved with the agreement from the service users. Risk assessments needed to include hazards and a review date. The head office must listen and consult service users regarding how they want to manage their finances. Service users information on their finances must be kept up to date, and explained to service users. The organisation must provide adequate dining space to meet the needs of all the service users. Version 1.10 31/5/05 7. 34 18 31/6/05 8. 5 5 by the 31/6/2005 9. 7 14,15 14/5/2005 and at all times 10. 11. 9 7 13 14,15,20, 31/6/2005 14/5/2005 12. 7 14,15,16, 20 23 31/5/2005 13. 28 31/6/2005 Bunyan Lodge Page 25 14. 17 12 The staff must ensure that the service users do not empty food from their plates in front of a service user whilst he is eating his meal. This must be undertaken in the kitchen. At all times 15. 16. 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 1 14 34 1 Good Practice Recommendations Ensure that the Statement of Purpose covers the items in the order given in Schedule 1 Service users in long-term placements have, as part of the basic contract price, the option of a seven-day annual holiday It is recommended that the staff team reflect the gender and cultural composition of service users The information in the welcome to Apex Care Homes procedures needed reviewing as most of the information provided related to older peoples homes Bunyan Lodge Version 1.10 Page 26 Commission for Social Care Inspection Clifton House Goldington Road Bedford MK40 3NF 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. Extracts may not be used or reproduced without the express permission of CSCI Bunyan Lodge Version 1.10 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!