Inspection on 01/12/08 for Bushbury Court Nursing Home

This inspection was carried out on 1st December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bushbury Court Nursing Home 04/01/07

Bushbury Court Nursing Home 13/03/06

Bushbury Court Nursing Home 26/10/05

Bushbury Court Nursing Home 30/09/04

Bushbury Court Nursing Home 10/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bushbury Court Nursing Home Hellier Road Bushbury Wolverhampton West Midlands WV10 8EE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rosalind Dennis     Date: 0 1 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Bushbury Court Nursing Home Hellier Road Bushbury Wolverhampton West Midlands WV10 8EE 01902444066 01902444065 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Barbara Smith Type of registration: Number of places registered: Heantun Care Housing Association Limited care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 21 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 21 Date of last inspection Brief description of the care home Bushbury Court is a care home providing nursing care for up to 21 people with dementia who are usually over the age of 65 years, on a continuing care basis. The provider is Heantun care Housing Assocation Ltd and people are generally admitted to the home direct from a hospital setting with fees paid by the local Primary Care Trust. The home is situated in the Bushbury area north Wolverhampton and is within easy walking distance of local shops, which includes a Library, hairdressers, pub, church and Care Homes for Older People Page 4 of 27 Over 65 0 21 Brief description of the care home doctors surgery. A local bus service stops nearby. The home consists of a single storey purpose built building. Twelve of the bedrooms are single occupancy and four twin rooms. The communal areas are spacious and homely. There is car parking at the front of the building, and an enclosed rear garden. People can obtain information about this service from the homes Statement of Purpose and Service User Guide. Inspection reports produced by CSCI can be obtained direct from the provider or are available on CSCI?s website at www.csci.org.uk. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was unannounced, in that the home did not know we were coming and the inspection was conducted by one inspector over a period of around 7 hours. All key standards were assessed during the day- that is those areas of service delivery that are considered essential to the running of a care home. Most people living at Bushbury Court are unable, because of their illness, to provide accurate feedback on their views of the home and the care they receive. The inspection involved observing interactions between staff and people living at the home, speaking with relatives, staff, and the manager and looking at records. We observed that all people appeared well cared for and staff were attentive in meeting their needs. Care Homes for Older People Page 6 of 27 Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was sent to the manager, Ms Barbara Smith for completion. The AQAA is a self-assessment that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed, Bushbury Court returned their completed AQAA to us within the given timescale. Information provided within the AQAA has been used to supplement the inspection process. The last key inspection of Bushbury Court took place on the 4th January 2007. We also conducted an Annual Service Review (ASR) on the 25th February 2008, when we looked at the information about the service we had received since the last inspection and made a judgement about when we would next do an inspection. As part of the ASR five relatives of people living in the home completed surveys for us and the feedback and comments we received were positive. As a result of the service not conducting health and safety monitoring as much as is required, the quality rating for this service has changed and is now 1 star. This means the people who use this service experience adequate outcomes. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Bushbury court has a good assessment and admission procedure, which ensures that people are only admitted to the home if the service is confident that it can meet their needs Evidence: We looked at the care records for three people, which shows that assessments are undertaken by the manager before people are admitted and this was also confirmed by one of the relatives we spoke with. Information had also been obtained from health and social care professionals involved in the persons care. The information from the assessments had been used to develop a care plan and identify potential risks to the individuals health, safety and welfare in the form of risk assessments and the care records we looked at showed these had been completed soon after the persons admission. Two relatives spoke of their satisfaction with the admission process and how pleased they have been with the care at Bushbury Court since their relatives Care Homes for Older People Page 10 of 27 Evidence: admission. The manager reports that the home provides information about the service in its Statement of Purpose and in an information booklet-we did not look at these at this inspection. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk assessments are generally well written and provide staff with information they need to meet peoples needs. Evidence: The people living at the home at the time of this inspection were unable to give their views on the home and the care provided, so most of this inspection is based on observation and looking at documentation to show how the home meets peoples needs. We observed staff interacting well with people who live at the home and people looked clean and appropriately dressed. Staff responded well with one person who became agitated. We looked at the care records for three people, which showed that care plans identify peoples preferences and provide information for staff on how to meet their short term and long term care needs. Staff spoken with were able to give accounts of the varying needs of people living at the home and how they meet those needs. A range of risk assessments were present on the care records we observed, however Care Homes for Older People Page 12 of 27 Evidence: the manager was advised to improve the way people are assessed for the use of bed rails, such as ensuring the risk assessment is individualised and based on current guidance. The home keeps good records of peoples dietary and fluid intakes and monitors peoples weight, however the home does not currently assess peoples nutritional risk at the time of their admission and on an ongoing basis. Although the manager confirmed the home is looking for a suitable nutritional assessment tool, the manager was informed this needs to be implemented promptly. The manager had provided information within the AQAA describing how relatives are involved in review meetings about peoples care and we spoke with one relative who confirmed that these meetings take place and viewed that they are useful. Information was available on care records to demonstrate that the home seeks advice as necessary from relevant healthcare professionals. Examination of a selection of medication administration record sheets found these to be completed accurately, with medication signed and accounted for. We observed where medication is stored and records showed that medication is stored at the correct temperature within the room. The temperature of the fridge used to store medication was satisfactory, however the records showed a different temperature and staff had not been recording accurate temperatures of the medication fridge for sometime. We brought this to the attention of the manager for staff to be made aware of how to record temperatures accurately, which is important so that medication is stored according to manufacturers instructions. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to exercise choice as far as possible so that they are able to maintain some of their independence and make choices that meet their needs and preferences. The home provides meals that offer people variety and cater for different nutritional needs. Evidence: A notice board in the corridor of the home displays photographs of events held at the home and also of two holidays, which a number of people went on in the summer accompanied by staff. During the inspection one person was enjoying folding napkins, two other people were seen comforting dolls and staff were chatting with people about daily events. Observation of care records showed that staff had sought information about people before their illness and staff gave examples of how this information is used to meet individual needs. Staff spoke about how they ascertain peoples likes and dislikes with them, or when this is difficult liaise with family members. Care Homes for Older People Page 14 of 27 Evidence: The manager acknowledges within the AQAA that records of activities are not always up to date and we also found this during the inspection. We spoke with one relative who was able to describe events, activities and what happens on a daily basis at the home, but this was not always reflected within peoples records. We informed the manager that staff need to improve their record-keeping to show how they have enhanced peoples well-being. Staff also spoke about the difficulties they can experience in providing activities if staffing levels are not sufficient, and we informed the manager of these comments. Meals in the home continue to offer choice and the meal plans we observed show that the home offers a wide range of meals and provides many opportunities for people to eat throughout the day. A discussion with the cook demonstrated they have a good knowledge of individual nutritional requirements and described how the home uses local fresh produce. Staff were observed providing assistance to people who needed help with eating and drinking. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear complaints procedure which ensures people know how to raise concerns and complaints. Staff are provided with training to equip them with the knowledge and skills to safeguard adults from the risk of abuse or neglect. Evidence: The home has a complaints procedure and two people visiting the home confirmed their awareness of this procedure and felt confident that if they had any concerns the manager or other staff would act quickly to ensure their concerns were acted upon. The manager confirmed to us that the home has not received any formal complaints. The manager described how if people raise minor concerns they are recorded within individual care records. We advised the manager that it is good practice to also record minor concerns within the complaints log, so that information is readily accessible to people who may request it and to assist the service with auditing and learning from any complaints and concerns. We have not received any recent complaints about Bushbury Court. The home has a copy of the local area multi agency adult protection policy and information was available to show that staff receive training in safeguarding adults and how to respond appropriately to people whose behaviour may challenge. The manager demonstrated good awareness of the Mental Capacity Act (MCA) 2005 Care Homes for Older People Page 16 of 27 Evidence: and a resource file is available in the office for staff to access. The Act governs decision-making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth and it is important that staff know how to put the Act into everyday practice. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Bushbury Court provides people with an attractive and clean place to live and further planned re-decoration will enhance both the appearance of the home and its suitability for people with dementia. Evidence: The manager described how carpets and furniture are cleaned on a regular basis and this was apparent on the day of inspection as for most of the day the carpets in the main lounge were being cleaned. Although this caused some disruption, as people were unable to sit in this room, staff managed the situation well. All parts of the home we observed were clean. The manager confirmed within the AQAA that the home has a rolling programme of re-decoration and replacement of fixtures and fittings. We looked at most of the bedrooms in the home, the decoration was generally satisfactory and the manager was aware of where attention was needed, for example in rooms where wallpaper borders have been peeled off. The home is currently using rooms designed for two people as single rooms, which seems an appropriate use of the space. During our observations of the environment, we observed that a bathroom was being used as an equipment store, however the room had not been fitted with a fire/smoke detection unit and the manager was informed of the need to take prompt action to ensure this room was used appropriately. It is identified within the homes AQAA that there is a need for more storage space in the home. Care Homes for Older People Page 18 of 27 Evidence: The manager discussed the homes intention for the development of the garden-which will be a positive development in providing sensory stimulation for people with dementia, at present there is little in the way of providing sensory stimulation within the internal environment, an area that the manager is keen to improve. Discussion with the manager confirmed her awareness of where improvements are needed in respect of infection control, such as the provision of specific bins and observation of training records show that staff receive training in infection control. During the inspection we found that a solution had been decanted inappropriately into a container in one of the bathrooms, and the manager ensured the container was removed. We looked at a copy of the report from Environmental Health who had visited the home recently, and the manager confirmed action would be taken to address areas needing attention. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Training opportunities within the home are good which ensures that Bushbury Court provides a well-trained and committed staff group who work positively to improve peoples quality of life Evidence: The staff personnel files we looked at contained all required pre-employment checks, which demonstrates the home only employs staff who are suitable to work with vulnerable people. We saw documents, which demonstrate the home provides new staff with a comprehensive induction. A member of staff recently appointed by the home confirmed they had received an induction and they spoke positively about the support they had received since starting at Bushbury Court. We looked at a selection of individual staff training records and the homes training matrix which shows that a wide range of training is provided-this includes training in safe working practices such as fire safety, as well as more specific training, for example Dementia care. Information was available to show that staff have access to formal supervision, although for some staff the manager acknowledges this may not have occurred as frequently due to staff sickness. Throughout the inspection staff were observed responding to peoples needs promptly and sensitively. We looked at staffing rotas, which gave a ratio of how many staff are Care Homes for Older People Page 20 of 27 Evidence: needed for numbers of people accommodated and we discussed with the manager that this should only be used as a baseline. The manager confirmed her awareness that staffing levels need to be calculated according to the dependency and needs of the people living at the home and that staffing levels change accordingly. Two visitors to the home viewed that when they visit there appears sufficient staff on duty, a member of staff viewed that staffing levels arent always sufficient and this was fedback to the manager. It appeared from our observations that there were sufficient staff on duty at the time of inspection, although it was apparent that staff were clearly working hard and were needing to closely observe one person who had become agitated. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager, Barbara Smith has the skills and knowledge to manage the home and to lead the staff team to ensure peoples needs are met. Gaps within health and safety monitoring means that people are not consistently protected from harm. Evidence: Barbara Smith has worked at the home for sometime in the capacity of Registered Manager and management experience is supplemented by recognised management qualifications. For the purpose of this inspection Barbara Smith had responded to a request by the Commission to complete an annual quality assessment document (AQAA)- this is an opportunity for providers to share with us areas that they believe they are doing well, and where they could improve. The information contained within the AQAA shows that the manager acknowledges the strengths and weaknesses within the service and is able to plan for improvement. Care Homes for Older People Page 22 of 27 Evidence: We looked at the collated results of surveys, distributed by the home in March 2008 which showed that peoples significant others were satisfied with the service at that time. Everyone who had responded confirmed they found the manager approachable and almost all confirmed they are involved in reviews of their relatives care. The AQAA notes that the service still needs to identify a means of assessing residents satisfaction with the service. The manager confirmed that the service does not have any involvement with peoples finances. Information was provided within the AQAA to confirm that servicing and maintenance of equipment is undertaken and policies and procedures are regularly reviewed. However when we looked at the records to show that weekly checks on the fire alarm are undertaken we found that checks had not been undertaken for at least four weeks, emergency lighting checks had not been performed monthly and the last date recorded for water temperature checks was June 2008. These are considered serious oversights and highlight a need for increased monitoring by both the manager and the provider to ensure those deemed responsible for the checks are undertaking them to the required frequency so that people living at the service are protected from the risk of harm. The manager confirmed that action would be taken to ensure the checks were done. The last recorded monitoring audit undertaken by a representative for the provider was August 2008- these visits must be undertaken monthly and a requirement is made as a result of this not taking place. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 12 The home must ensure that it meets health and safety requirements and legislation. This is to ensure that unnecessary risks to the health or safety of people are as far as possible eliminated. 13/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 8 The home needs to improve the way people are assessed for the use of bed rails such as ensuring the risk assessment is individualised and based on current guidance Staff need to provided with guidance on how to use the thermometer for recording the temperature of the medication fridge. This is to ensure that the temperature is monitored and recorded accurately so that medication is stored according to manufacturers instructions. The provider needs to ensure there is a means of establishing that agencies with whom they contract have appropriate recruitment measures in place. This is to ensure that people living at the home are cared for by staff 2 9 3 29 Care Homes for Older People Page 25 of 27 who have been suitably checked. 4 33 The provider must ensure a representative of the organisation visits the service on an unannounced basis at least once a month. This is so that the standard of care, performance and practice of the home can be monitored. Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 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!