Inspection on 26/05/09 for Bushey House

This inspection was carried out on 26th May 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bushey House 23/05/07

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bushey House 57-59 High Street Bushey Hertfordshire WD23 1QN     The quality rating for this care home is:   zero star poor 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: Marian Byrne     Date: 1 7 0 6 2 0 0 9 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. that people have said are important to them: They reflect the things 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 26 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Bushey House 57-59 High Street Bushey Hertfordshire WD23 1QN 02084218844 01089509387 linda.simpson@barchester.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Barchester Healthcare Homes Ltd care home 60 Number of places (if applicable): Under 65 Over 65 60 60 old age, not falling within any other category physical disability Additional conditions: 0 0 The home may accommodate three older people who require personal care. They may accommodate 60 older people who need general nursing care and convalescent care. This home may accommodate 10 persons aged 50 years or more with a physical disability who require nursing care. Date of last inspection Brief description of the care home The Bushey House Beaumont is a 19th Century Grade II listed mansion with a purpose built extension in keeping with the original house. The view over a lake and parkland can be seen from the library, dining room and patio. The home is spacious and furnished and decorated to a high standard in keeping with the period style of the building. Individual rooms have en suite facilities and in addition to these there are assisted bathing and toilet facilities to meet the needs of elderly and physically disabled residents. The home is close to the local amenities of Bushey High Street. Details about the home are contained in the Service User Guide, brochure and Care Homes for Older People Page 4 of 26 Brief description of the care home welcome pack that are available on request from the manager together with a copy of CSCI inspection reports. Details of current fees can be obtained direct from the provider. Care Homes for Older People Page 5 of 26 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: zero star poor 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 key inspection was carried out by two inspectors over one day and by one inspector over a further day. We toured the premises, spoke to staff and residents and spent time with the persons who are responsible for running the home, the Registered Manager and the General Manager. We inspected records pertaining to the care of the residents and to the recruitment and training of staff. We spent time observing the interaction between staff and residents. We spoke to visitors to the home. Prior to the inspection we sent out surveys to the residents and the staff of the home. We had a very high response to the surveys from staff. We conducted an Annual Service Review in May 2008 at that time we did not have Care Homes for Older People Page 6 of 26 concerns about the care of the residents. Prior to this inspection we asked the Registered Manager of the home to complete an Annual Quality Assurance Assessment (AQAA). This was returned in a timely manner and indicated that all the residents were cared for in a manner that promoted their independence, health and dignity. This did not reflect what we found on our inspection. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 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 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who are admitted to this home cannot be sure that their needs will be assessed appropriately therefore peoples needs may not be identified and met accordingly. Evidence: We looked at the care plans of four people and found that two people had been admitted to the home suffering from dementia. The home did not have staff trained to meet the needs of people who have dementia. Consequently they were not able to meet the residents needs. (This is explored later in this report). The other care plans did not contain sufficient information to ensure the residents needs could be recognised and therefore met. Care Homes for Older People Page 10 of 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are admitted to this home cannot be sure that they will be treated in a manner that recognised their needs or cared for in a manner that promotes the dignity of the resident. Evidence: Care plans did not contain sufficient information to enable staff to meet the needs of the residents. They did not offer any guidance to staff on how needs were to be met or care carried out. An example of this was one residents care plan contained the following: Mental and Cognitive State - Has dementia very hard to care for them at times as they will hit punch and kick you. Observe hourly in bed. There were no directions to staff on how to recognise and deal with the persons complex needs. The care plan further states that this person will not always allow the care staff to meet their personal care needs. There was no guidance for staff on how to manage this situation. There were notes on file to record when the resident was aggressive. There was no attempt made to understand why the person may have been aggressive or what may Care Homes for Older People Page 11 of 26 Evidence: have triggered this aggression. Another example was transfer papers from the hospital stated that the person suffered from depression and had attempted suicide. This information was not transferred to their care plan which could mean that they were not protected from possible self harm. Another residents daily notes showed that they had a strip wash and dressed, shave given. They were wandering all around the room without clothes when tried to get them back to their room they were very aggressive and abusive. The notes go on to state that the person in the next room was very upset and agitated, relative informed. There was no other information. We observed care to be given in a manner that was task orientated by this we mean that staff focus on the task to be carried out rather that the person who needs to be cared for. An example of this is where we observed staff congregated in a residents room to discuss daily tasks they ignored the resident whose room it was leaving them angry and frustrated. We spoke with residents who were left partly dressed where the staff walked away and left them without explanation. We observed staff leaving breakfasts for people who wished to sleep. We observed staff speak about people who were present and not include them in conversation. We observed care being delivered in a manner that did not promote the dignity of the person. We observed two very senior staff walk past a room where the person inside it was shouting for help. We observed call bells go unanswered. We asked the General Manager if their call bell system listed the time each bell takes to be answered. We were told that it does. We asked for a record of this for the past week. We asked for this information on two occasions. It was not produced for us by the end of the inspection. We observed staff leave medication for residents and then sign that it had been taken when they couldnt have known if it was taken or not. When we looked at medication on our second visit we noted that the storage and recording of controlled drugs was confused and did not represent what was given and when. An example of this was that if a person was in hospital for a given time for example three weeks the home carried on their medication as thought there was not break. This medication should be returned to the Pharmacist. We left an immediate requirement that an audit was done on medication within 24 hours. We were told that this was done. Care Homes for Older People Page 12 of 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some of the people who live in this home will not have their needs want and wishes identified and met. Evidence: As already stated in this report the information on the care plans is not sufficient to recognise or identify the needs of the residents, therefore it is not possible for staff to meet the daily social, emotional and spiritual needs. We noted that people who are able to care for themselves or need little care appear to have a good life style in the home. We saw that they were served in the restaurant before those who needed assistance despite the fact that those who needed assistance were in the dining room longer. Some people were placed in the dining room for up to an hour before they were served their lunch. They did not have anything to occupy themselves for that time. Some were left in wheelchairs and had fallen asleep with their heads to one side and to us they looked uncomfortable. We observed staff (in view of the Manager) place a large bib on a resident who was asleep. This did not respect the humanity or the dignity of the person. We observed staff assist residents to eat lunch in a manner that did not promote their dignity. We observed staff move away from the person they were assisting without excusing themselves or offering an apology or a reason. We Care Homes for Older People Page 13 of 26 Evidence: observed staff offer food to individuals without stating what they were offering or giving them a choice of what to eat next. We observed staff speaking to the person they were asisting to eat throughout the meal. Visitors are welcomed to the home at all reasonable times. On the day of the inspection there was a constant stream of visitors to the home. We found the food to be of a high quality and was found to be fresh, tasty and well presented, however some residents did not get the opportunity to enjoy their food at its best or at a time that suited them. Care Homes for Older People Page 14 of 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some of the people who live in this home are not protected and do not have their concerns and complaints addressed. Evidence: This home has been the subject of two Safeguarding referral. This means that there were concerns about the safety of individuals. One issue was raised by a staff member who was concerned about the care of some of the residents in the home. We made a referral following our first visit as we were also concerned for the care of the residents in the home. We spoke to visitors who were angry with the management of the home and felt that they were wasting their time complain as they were not listened to. We spoke to staff and visitors who told us that their concerns are not listened to and that complaints have been left unattended. Care Homes for Older People Page 15 of 26 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. Most people who live in this home can be sure that the environment will meet their needs. Evidence: On the days we visited the home we found the environment to be clean and fresh. We found rooms to be decorated to reflect the taste of the residents. The communal areas were bright and clean and freshly decorated. The dining room overlooks the ground which are extensive, well kept and pleasing to the eye. There was garden furniture outside for the use of the residents. This was in good condition and offered sun protecton. The people who were admitted who had a diagnosis of dementia were in a part of the home that they could find difficult to navigate thus reducing their independence. People who have dementia are better placed in an environment where they can be observed and staff intervene if any danger presents itself. This was not the case for the residents in the home. Care Homes for Older People Page 16 of 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home cannot be sure that the staff are sufficiently trained or sufficient numbers are on duty to meet their needs or ensure their safety. Evidence: Staff are without leadership and guidance. Prior to the inspection we sent surveys to staff and residents to allow them to tell us in confidence their experience of living or working at Bushey House. We had a very high response from staff who were concerned about the care of the people who live in the home. We found their concerns to be valid. Some of the staff who responded were very specific about their concerns and about the manner in which they are managed. We passed this on to senior management in the Company who told us that they will address the issues. Some of the concerns that we raised were that not enough staff were on duty to meet the needs of the residents. They told us that if a member of staff was off sick they would not be replaced. On the day of the inspection we found that the Registered Manager and General Manager could not produce a rota of staff who were on duty on the day of the inspection or in the past weeks and months. We saw names in a diary which appeared to constitute a rota. It is a legal obligation to maintain rotas. We looked at staff work sheets in an effort to understand who was working and for how long. We found one member of staff who had worked everyday except one in the past three months. Neither the General Manager of the Registered Manager was aware of Care Homes for Older People Page 17 of 26 Evidence: this nor had a risk assessment being put in place to show that this staff member was able to meet the needs of the residents at the end of a very long shift. This indicates that the staffing hours are not managed. On the first day of the inspection after staff had assisted residents with lunch we went to the staff room and found seven staff members there on their own lunch break, leaving two staff members to meet the needs of the residents. We pointed this out to the General Manager who appeared unaware of the situtation or the risk the residents were at. Staff were not up to date on mandatory training nor did any staff on duty on the day of the inspection have specialist dementia training. We found staffing recruitment to be generally satisfactory however one staff member did not have two references on file. Staff appeared to be over worked. One staff member we spoke with had to assist nine people with their lunch. Some of these people were in their rooms and some in the dining room. Those in the dining room had to wait until those in their rooms had been assisted with lunch. This means that those people in the dining room had to wait an unreasonably long time for lunch. Morale of staff was very low. All those who responded to the survey said that they would like to speak to an inspector but were frightened to for fear of losing their jobs. We left an immediate requirement on staffing levels in the home and on the hours worked by one member of staff. At the time of writing this report we have been told that the issues mentioned have been addressed. Care Homes for Older People Page 18 of 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home cannot be sure that it is managed and run in their best interests. Evidence: As shown throughout this report the home is not well managed nor is it run in the best interests of the people who live there. People are admitted without the home being able to meet their needs. We observed residents to be treated without respect and dignity. We observed care to be given in a task orientated manner. We observed residents wait unreasonable times for lunch and they they were not offered assistance in a manner that promoted their dignity. We were told that complaints were not listened to. We made a safeguarding referral to Adult Care Service because we were concerned at the lack of care to the individuals. We observed that medication is not given in the correct manner. We observed that medication was not stored and recorded in the correct manner. We observed very low morale with staff. We observed lack of control of managing rotas. Staff were not trained to carry out their jobs. Staff Care Homes for Older People Page 19 of 26 Evidence: told us via their survey that they were frightened to talk to us. They passed on some information to us that concerned us. We have no way of verifying all the information we were given therefore we passed this information on to the senior management of the Company. We were not given information that we requested on the call bell system. We observed the General Manager and the Registered Manager ignore a resident who was calling out in distress, they did attempt to meet this residents needs not did they get staff to meet their needs. We observed that there were not sufficient staff on duty on the day of the inspection. We observed a high number of staff off the floor having lunch at the same time. We observed the needs of more ambulant residents being met before the needs of those who were unable to ask for their needs to be met. The Manager of the home was unable to provide us with details of the hours staff worked. We had to look at their pay claims to establish the hours worked. They were unaware of the very long hours one member of staff had worked. Overall staff were without direction and management, however the management of the home appeared to be unaware of this. It should be noted that most of the issues raised in this report were fed back to the senior management of the Company once the information was available to them, they acted very quickly to start to address the issues raised in this report. When we returned for our second visit plans were in place to address the issues raised. The home does not look after any of the residents monies. Care Homes for Older People Page 20 of 26 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 21 of 26 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 1 2 14 The Registered Manager 08/07/2009 must ensure that people are not admitted into the home until a full assessment has been carried out and that the home can meet the needs of the residents You must do this to ensure you can meet the needs of the people who are admitted to the home. 2 9 13 The Registered Manager 18/06/2009 must ensure that medication is administered, recorded and stored appropriately. You must do this because the welfare of the resident is dependent on getting their medication. 3 27 18 The Registered Manager 28/05/2009 must ensure that there are sufficient staff on duty to meet the needs of the people who live in the home. You must do this because the residents were not having their needs met. 4 27 18 The Registered manager 28/05/2009 must ensure that staff work hours where they will have a break to ensure they own health and to ensure they are fit to carry out the task of caring for very vulnerable frail people. You must do this because it Care Homes for Older People Page 22 of 26 is important that staff have sufficient rest and that the manager of the home knows the hours the staff work. 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 7 15 Care plans must contain 31/08/2009 sufficient detail and instructions to staff to ensure that care is delivered in a person centered manner that promotes the dignity and independence of the resident. You must do this because the care of the residents does not always meet their needs. 2 8 14 The Registered Manager 31/07/2009 must ensure that care is delivered in a manner that promotes dignity and health. You must do this because the health and emotional welfare of the residents must be promoted. 3 12 12 The Registered Manger must 31/08/2009 ensure that the residents of Bushey Hall are cared for in a manner that promotes their choices and expectations. You must do this because the people living in your home should have the Care Homes for Older People Page 23 of 26 freedom to live their lives as they choose not as the routines of the home dictates. 4 14 16 The Registered Manager of 31/08/2009 the home must ensure that all the residents of the home have their meals served to them at a time they choose and the opportunity to enjoy the food the home offers while it is at its best. You must do this because it is important that the residents get to enjoy their food at a time they choose. 5 16 22 The Registered Manager 31/07/2009 must follow the Companys complaints policy and conduct investigations where appropriate. You must do this because it is important that residents, staff and their families are listened to and complaints acted on. 6 18 13 The Registered manager ensure the health and welfare of the residents is safeguarded and that staff are listened to when concerns are raised. You must do this to protect the residents. 7 31 10 The Registered Provider must ensure that this home is managed in the best interests of the people who live there. 31/07/2009 31/07/2009 Care Homes for Older People Page 24 of 26 You must do this because the care of the people who live in the home is dependent on this. 8 32 12 The Registered Providers 31/07/2009 must ensure that the home is managed in a manner that promotes openness and empowers staff and residents to express their views and opinions without fear. You must do this because residents and staff must feel free to express options and have those opinions listened to. 9 37 17 The Registered Manager must ensure records are kept to indicate what members of staff are on duty ie rotas. You must do this because it is necessary to know what members of staff are on duty at all times. 31/07/2009 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 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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 26 of 26 - 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!