Inspection on 25/05/07 for Bushell House

This inspection was carried out on 25th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bushell House 04/10/05

Bushell House 22/04/05

Bushell House 09/11/04

Bushell House 27/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Belvidere Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Bushells House Mill Lane Goosnargh Preston Lancashire PR3 2BJ Lead Inspector Mr Patrick Rooney Unannounced Inspection 10:00 25th May 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bushells House Address Mill Lane Goosnargh Preston Lancashire PR3 2BJ 01772 865225 01772 865503 office@bushellhouse.freeserve.co.uk 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) The Trustees Of Bushell House Mrs Susan Jones Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person shall at all times employ a suitably qualified Manager. 4th October 2005 Date of last inspection Brief Description of the Service: Bushells House is situated in the rural village of Goosnargh and provides personal care to a maximum of 31 service users of both sexes. The home is large, luxurious and set in a beautiful garden. There are several communal rooms including the library, upstairs lounge and dining room. All the individual rooms are for single occupancy and are large and very well appointed; many have en suite facilities. Fees for the home currently range from £342.50 to £441.00 per week Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit and took place over a period of six hours. The information in this report was gathered from an Annual Quality Assessment completed by the manager of the home, discussion with the manager and discussion with staff individually. Private discussions were held with residents. The care of three residents was case tracked, their assessments and care plans were seen and the inspector interviewed them regarding the care they receive. Other residents were spoken to in the lounges. Questionnaires were received from residents and relatives and GPs serving the home. A tour of the premises took place and documents were seen by the inspector. Staff records were examined. What the service does well: Bushells House provides excellent personal service and care to its residents and their relatives. It has very good relationships with General Practitioners and other support services. The inspector found this to be the case from discussion with residents, relatives and staff. Questionnaires completed by residents and relatives also confirmed this to be the case. Their comments include. ; “I regard this as my home, staff are good and considerate, our privacy is always respected and staff never gossip”. “The home is marvellous, I couldn’t ask for better.” “There is a happy atmosphere here for everyone”. A relative commented “We think of Bushells house as a country house hotel to a residential home, nothing is ever too much trouble for the care staff, wish there were more places like this, we really appreciate the respect staff show to residents.” There is a good stable staff team which works well together there is good management and clear lines of accountability. The trustees are in regular contact and ensure the home maintains a high standard. Staff training is a high priority and staff are well supported with regular supervision, appraisal and meetings. Regular residents meetings are held and in addition to being accredited with two external quality assurance registrations RDB and IIP the home carries out its own quality assurance survey. Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment and admission process is good and ensures the home is able to meet needs identified. EVIDENCE: Prior to admission prospective residents are provide with good information about the home and are given the opportunity to visit prior to accepting a place at the home. Visits may also be made on a day or weekend basis to enable people to get a feel for the home. A format for carrying out a full needs assessment has been developed and implemented by the home. This includes medical, social and personal needs. Risk assessments are carried out to provide safety and protection for residents. The assessments of three residents were looked at and their care discussed with them. The assessments form the basis for care plans, which are agreed with residents and their representatives. Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 9 While there is a section in the assessment process for including personal and social history in files looked at this has not always been completed. This information is necessary if a person centred approach to care is to be more effective. Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans contain good detail and ensure health care needs of residents are met and ensure care is carried out respecting the privacy and dignity of residents. Medication policies and procedures are good and ensure medication is given out safely. EVIDENCE: The care plans of three residents were looked at and the care they receive was discussed individually with them. The care plans were easy to follow and had been drawn up in cooperation with the resident and their representatives. Care plans are signed by residents or their representatives. Any risks are identified and discussed with the resident and actions recorded of how to deal Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 11 with them. Independence of residents is seen as a priority and staff are trained to encourage residents to do as much for themselves as they can. Assistance is offered if and when required. Care plans are reviewed monthly with the involvement of residents. There are good contacts with other health care professionals including district nurses and GPs. Residents expressed satisfaction with the levels of care they receive and feel that their privacy and dignity is respected in the way staff care for them. Comments from residents about their care include; “I regard this as my home, staff are good and considerate, our privacy is always respected and staff never gossip”. “The home is marvellous, I couldn’t ask for better.” “There is a happy atmosphere here for everyone”. A relative commented “We think of Bushells house as a country house hotel to a residential home, nothing is ever too much trouble for the care staff, wish there were more places like this, we really appreciate the respect staff show to residents.” Medication records were looked at and the medication trolley was inspected. Only named staff who have had training are able to give out medication. All records were well kept and up to date. An audit of controlled drugs medication was carried out correct amounts of medication were in the supplies. The controlled drugs register was looked and records maintained correctly. There is good support and assistance from the homes pharmacy. With regard to receipt of medication, record sheets did not have the date medication was received. To facilitate the audit of all medication received the date of receipt should be recorded. Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides residents with choice and routines are flexible, this ensures they are able to exercise control in everyday life. EVIDENCE: Bushells House provides an excellent, flexible lifestyle, in which their lives are not organised for them, however activities and facilities are available for those who want them. Good links have been built up with the local community including the local school and church. One resident is due to do a reading at a special church service in the near future. Residents are able to access the local community and enjoy walking around the village. The inspector looked at the activity folder, in which there was recorded a variety of activities to suit individual residents needs. The home has recently installed a computer for use by the residents. This provides access to games and an email facility, which enables some residents to keep in contact t with family overseas. There is an indoor gardening club, which is facilitated by the home’s gardener. Residents are able to pot their own plants and bulbs. Bushells House provides flexibility with regards to daily routine and each resident has their own preferred getting up time in the morning. Menus Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 13 showed that there is a good variety of food available and residents are asked what they like. There are always alternative meals available for those who wish. Meals can be taken in resident’s own rooms if they prefer to eat in private. Residents told the inspector they are happy with the meals they receive. Residents are encouraged to maintain their own financial affairs as long as possible. Information regarding access to independent advocacy services is available in the home. Bedrooms are personalised and residents are able to bring items of furniture, pictures and ornaments with them when they are admitted to the home. Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure, relatives and residents are confident that their concerns are listened to, taken seriously and acted upon. The procedures ensure residents are protected. EVIDENCE: There is a complaints procedure available to residents and there families, this is available in the service users guide and is on the homes notice board. Residents confirmed they are aware of the complaints procedure and told the inspector that any concerns they have are dealt with promptly. The homes manager and senior staff are always available in the home; residents said they are very approachable and helpful. One resident said, “I have every confidence in the management and feel that I am able to raise anything I am concerned about”. All complaints are recorded including outcomes. The inspector looked at the complaints book and saw that complaints had been dealt with satisfactorily. The inspector saw the homes vulnerable adults procedures including the whistle blowing policy. These are in line with the Department Of Health, ‘No Secrets’ paper. Staff on duty were spoken . Staff on duty were spoken to individually and said were aware of the whistle blowing policy and said felt confident to approach the manager if they had any concerns. Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 15 Fifteen of the twenty-four care staff employed by the home have received training in the protection of vulnerable adults. There is a manual available to staff about understanding abuse and the manager has prepared a training workshop for staff about adult protection. Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home offers an excellent standard of décor and furnishings, which provide residents with a homely clean and comfortable environment. EVIDENCE: The inspector toured the home and viewed the rooms of residents, they observed them to be comfortably furnished and contained items residents were able to bring with them when they were admitted to the home. Accommodation in resident’s rooms is of a high standard and provides privacy and comfort. Public areas of the home were seen to be comfortably furnished and decorated. Bushells house is a grade two listed building and provides spacious communal rooms and resident’s rooms. All residents spoken to said they were happy with Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 17 accommodation provided by the home. Bathrooms are spacious and provide good space for two carers to assist if required. There is an on going programme in place for refurbishment and decoration. Plans are in place to refurbish the passenger lift. A long term development plan is in place to ensure the home is constantly being improved. There are very good infection control procedures in place and domestics employed to ensure the home is always kept clean. During the visit the home was observed to be spotlessly clean. Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides the right numbers of trained and experienced staff on rota, to meet the needs of residents. EVIDENCE: The inspector spoke to management and interviewed three staff. Rotas and staff records were examined. It was noted that there is a stable staff group who have the experience and skills to provide care needed for residents living in the home. There is a thorough staff induction programme and provides a good basic training for care staff. Records show that above 50 of the staff employed in the home are qualified to NVQ 2 or above in care. The trustees and management staff are committed to ensuring there are good number of staff with NVQ 2,3, and 4. Currently all senior staff have NVQ3. Staff supervision and appraisal records were seen and showed that staff training needs are identified and appropriate training provided. All staff are required to undertake mandatory training. Questionnaires received from residents and relatives confirmed that staff provide the right level of support to residents. Rotas showed that there are sufficient numbers of staff on duty to meet the needs of residents. Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 19 Residents said that staff are very friendly and approachable, and said all staff are very good and helpful. The files of staff were viewed and showed that all necessary recruitment checks are made including Criminal Records Bureau checks. References are taken up and interviews held prior to a post being offered. Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well managed, which ensures residents interests are protected and health and safety issues are promoted. EVIDENCE: Registered manager has many years experience in management and has completed the Registered Managers award and an HNC in caring services. She is currently completing the ILM level 5 in management. There is a clear management structure in the home with good lines of accountability. Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 21 Residents and staff told the inspector that the manager is very approachable and that any issues arising are appropriately dealt with. There are good relationships with the trustees, who are regularly involved and ensure the home is well run. Residents’ views are taken seriously and resident surveys have been carried out. The last residents’ satisfaction survey was carried out on 16/5/07. All questions asked scored over 90 satisfaction and in some areas 100 . This was reach in relation to staff responding to residents when they required help when ringing on the call system. Bushells house is accredited with two external quality assurance accreditations the RDB and IIP. Annual assessments are carried out to maintain these. Staff meetings are regularly held, and staff receive supervision and appraisals. Staff are encouraged to take part in the decision making process. The home assists with some resident’s personal allowances, these are kept in a safe and good records are maintained of any transactions. All the homes policies and procedures have been reviewed and updated. Health and safety is taken seriously and staff receive mandatory training in moving and handling, health and safety and first aid. All safety certificates and risk assessments are carried out and are up to date. Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 4 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 4 4 X 4 Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bushells House DS0000009819.V336177.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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. 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