CARE HOMES FOR OLDER PEOPLE
Bushmead Court 58/60 Bushmead Avenue Bedford Bedfordshire MK40 3QW Lead Inspector
Dragan Cvejic 10 and 14
th th Unannounced Inspection November 2005 11:00 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 Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 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. Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Bushmead Court Address 58/60 Bushmead Avenue Bedford Bedfordshire MK40 3QW 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) 01234 353884 Calsan Limited Mrs Anne Bentley Care Home 27 Category(ies) of Dementia - over 65 years of age (27), Old age, registration, with number not falling within any other category (27), of places Physical disability over 65 years of age (27) Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st May 2005 Brief Description of the Service: Located in a quiet residential street, close to city centre and other local amenities, this grade II building provided environmentally pleasant accommodation to service users. The home generally catered for elderly frail people, but in recent time had developed service suitable for service users with dementia. However, the home wanted to maintain balance of these different service users conditions. The building contained 23 single and three double bedrooms, 20 with en-suite facilities, spread over two floors. Two of double bedrooms were used for single occupancy. High ceilings, domestic furniture with a few antique pieces created an environment liked by service users. Back garden offered combination of paved patio area and beautifully maintained grassed area with flower beds. The home had parking in the front of the house. Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. It was carried out during two visits, the first on 10/11/05 from 11.00 to 3.00pm and the second visit on 14/11/05 from 7.00 to 10.30. The manager and the owner were present on the second day. Case tracking was used as the main methodology and two service users were followed through, although 6 files were inspected. Since the last inspection the previous manager had left and a new manager was in post. What the service does well: What has improved since the last inspection?
The new manager introduced some changes in working practices. Now, staff members were delegated appropriate tasks, to plan, monitor, and ensure that they were done appropriately. For example, one staff member was responsible
Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 Page 6 for all weight charts kept in the home, another for infection control and so on. With this delegation, staff involvement and initiative was encouraged and empowered. Although only 3 staff had completed their NVQ, the other seven staff members had recently started this training programme and all new staff were encouraged to enrol. Supervision content was simplified and made more user friendly, which junior staff, in particular, liked. Admission assessment forms were much better filled in for recently admitted service users than for the users admitted under the previous manager. Medication records were more accurate and the manager had introduced “double” signing while the new recording process becomes routine. The home had new hoists, two new laundry trolleys, breakfast trays and new table cloths were ordered to be hand made and were almost ready for collection. The equipment and aid used by service users was regularly reviewed and checked and a service user proudly stated: “I have got a new hearing aid. This is perfect, I can switch off if I want to, but I also hear much better with this new one.” What they could do better:
The first page containing the admission and basic details in some cases did not have an admission date recorded. This needs to be reviewed and admission dates added. The care plans were not precise enough and the description did not mach the identified needs. This should be rectified. Care plans and risk assessments and other documents on service users were not consistent and some risks were not addressed although they were identified in care plans. Some files were missing a risk assessment sheet that needed to be added. Medication trolley was too small for the boxed stock of medication. The owner undertook the responsibility to address this issue with the pharmacist and find the solution either in a bigger trolley or medication being delivered in blister packs. Some staff needed wider knowledge of medication and the manager was aware that training for this needed to be organised. A personal property list needed to be updated when new personal belongings come in and when the old recorded items were discarded. The home should start using tablecloths, as dining tables were quite sticky on both the days of the inspection. Small tables should be used for service users in wheelchairs when they could not sit comfortably at the big table for their meal times. The manager should attend the POVA training that was already booked and then organise POVA training for all staff. The staff member responsible for users’ money held in the home must arrange for signatures on records of transactions. The manager should continue with her training that had started already and apply for registration. She should continue with the delegation of specified
Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 Page 7 responsibilities, as this management style empowers staff and shows the competence of the manager. 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. Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 Page 8 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 Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 The home provided accurate and up to date information about services offered, enabling service users to make an informed choice when choosing the home. The admission procedure was appropriate and ensured only service users whose needs could be met were offered a place in the home. EVIDENCE: The home combined the statement of purpose and service users guide into one document. All necessary information was provided and reviewed to illustrate the home accurately. It stated details of the trial period too. The contract contained all required elements including the fee payable. Contacts inspected were signed. The admission assessment form used recently was filled in much better that forms used in the past. On some old forms the admission date was not recorded. Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Although progress was made in this area, care plans were not fully accurate and up to date in all checked files and did not match all risk assessments. Some service users were happy with their care plans. Medication trolley was too small for the amount of medication kept in it and presented a risk for mistakes. EVIDENCE: Some inspected care plans were not accurate. For example one plan stated that a service user was deaf, but used a hearing aid. Some files did not contain risk assessments and some risk assessments did not cover all assessed risks, for example when a service user did not use the lift and felt fearful of the use of it. Service users were encouraged to keep control over their health care needs. One user stated that he had arranged to get a new, different type of the hearing aid and was pleased that he kept the responsibility for maintenance of it. The manager also showed how the home successfully dealt with pressure sores. Medication process was much safer, records were accurate, but the trolley where the stock was kept was too small and the owner took on the
Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 Page 11 responsibility to review it with the pharmacist and tried to get medication delivered in blister packs. Service users were very much respected and their abilities were encouraged. A service user climbed the stairs, became breathless, but was proud of the independence gained regarding the use of stairs. Several service users had their favourite newspapers delivered. One service user was in control of her money, while the majority were supported by staff and relatives. The records of transactions were accurate. Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15 Various and stimulating activities organised in the home met service users needs. Table cloths must be used on the dining room tables to improve hygiene and as they are preferred by service users. EVIDENCE: The manager was still overseeing the activities programme in the home. Service users stated that the activities were meeting their needs and that their preferred activities were incorporated into it. A service user said: “We do not like bingo so much, so we play dominoes, talk about the past and read a lot. We have a library service visiting us here.” Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The home had a displayed complaint procedure that clearly stated how complaints could be made and treated by the home and how to take it further if an unsatisfactory outcome was reached. The new manager and the staff needed updated POVA training to ensure full protection of service users. EVIDENCE: The home did not have any formal complaints. An informal complaint made by a service user was investigated and measures were taken to improve services. The manager stated that there was a plan for her to attend POVA training. The other staff had not planned for this training at this stage and the manager was aware of the need. There were no staff referred to the POVA register. Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,24,25,26 The home was located in a grade II listed building in a desirable area and environmentally met the needs of service users. EVIDENCE: The homes’ location was very attractive, being in a quiet residential street, not far from the main facilities. The building was well maintained and was accessible to all service users throughout, including the safe back garden. The garden was, in particular, attractive and well maintained. The maintenance man was multi skilled and very effective in his work. Shared facilities were comfortable and renewal furniture programme ensured that service users enjoyed all the facilities in communal areas. Service users were encouraged and were pleased to bring in their own furniture. A service user stated: “I love my room. I brought in my furniture and made my room my new home.” The home was bright and clean and the owner’s efforts to maintain the high standard of furniture, facilities, cleanliness and comfort were very much
Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 Page 15 appreciated by service users. Several service users commented on the pleasant environment they had. The safety of the environment was ensured by regular checks of hot water temperatures and infection control measures in place. Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The home employed a sufficient number of skilled and committed staff that were able to respond to the needs of service users and ensure a good level of care was offered to each individual. EVIDENCE: The home’s rota demonstrated that sufficient staff were employed on each shift to respond to the needs of service users. The manager engaged one staff member to start a shift one hour before the day-time team, to cover the peak, getting up period. The presence of the owner, a registered nurse, was very beneficial to the home and service users, in terms of recognising particular needs related to health care issues. The NVQ training was promoted and a significant number of staff had started this training. Recruitment was successful and the staffing structure was complete. When cover was needed for holidays and sickness, the manager relied on bank staff, staff normally working in a “sister” home, from the same company. All new staff were vetted according to the company’s employment procedure and all checks were made prior to employing staff. Staff attended mandatory training and stated that they benefited from these sessions. However, the staff, including the manager did not attend POVA training, but the training was booked for the manager. The rest of the team would be trained upon the manager’s attendance of this training. Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,35,36 The home was managed in an open, creative and inclusive way and service users benefited from appropriate leadership. The manager needed to register with the authority. EVIDENCE: The manager had been in the post for a couple of months, since the previous manager left. She was internally promoted to this post and had a good knowledge of service users, staff and the home. However, she had started her management training recently, to improve her management skills and knowledge. She was well supported by the owner. She had just started her NVQ4 and RMA training. Her style was appropriate and staff commented that they felt well supported and appreciated the inclusive, open and positive atmosphere created in the home. Service users were encouraged to keep their money as long as they wanted to and could manage it. Some users confirmed that they control their money. Two users stated that they had asked the home to help them with financial
Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 Page 18 matters. Records and transactions were recorded, but not all transactions were signed. The lists of personal possessions were not all updated and kept up to date with the appropriate dates and signatures. Staff supervision plan had just been created and the manager had started the process that would ensure the required number of formal supervision sessions was achieved. The content of supervision also changed as staff expressed their wish to keep it simpler and more straightforward. Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 Page 19 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 3 3 2 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 X X 2 3 X X Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 Page 20 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. 1. 2. Standard OP3 OP7 Regulation Schedule 3 15 Requirement The admission assessment forms must contain the date of the admission. The care plans must contain accurate and updated information about the assessed needs of service users. Medication must be stored in an orderly way, either by being packaged in blister packs or in a bigger medication trolley where it would be possible to keep it in an orderly way. The home must use tablecloths in the dining room to improve the attractiveness of the food served. This was a recommendation from the last inspection and the cloths were made but still have not been used. The manager and the staff must attend current POVA training and keep their knowledge of this subject up to date to ensure the effective protection of service users. All transactions made on behalf of service users must be dated
DS0000014995.V266403.R01.S.doc Timescale for action 15/01/06 15/01/06 3. OP9 13 30/01/06 4 OP15 13 30/12/05 5 OP30OP18 13 31/01/06 6 OP35 Schedule 4 31/12/05 Bushmead Court Version 5.0 Page 21 and signed preferably by service users, or, if not possible, by their representatives. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP28 Good Practice Recommendations The care plans and other documents held in respect of each individual should correspond to each other and address clearly the main areas of identified needs. The home should encourage more staff to attend NVQ training in order to meet the 50 ratio of NVQ trained staff. This was recommended on the previous inspection. The home reacted and enrolled more staff on the training, but the required percentage was still not achieved. The manager should apply to register with the registration authority. The lists of personal property of service users should be kept up to date, dated and signed when changes are recorded. 3 4 OP31 OP35 Bushmead Court DS0000014995.V266403.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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