CARE HOMES FOR OLDER PEOPLE
Bushmead Court 58/60 Bushmead Avenue Bedford Beds MK40 3QW Lead Inspector
Dragan Cvejic Announced 31 May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Bushmead Court Address 58/60 Bushmead Avenue Bedford MK40 3QW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01234 353884 Calsan Ltd Sandra Hopper Care Home 27 (27) (27) (27) Category(ies) of OP - Older People registration, with number DE(E) - Dementia Over 65 of places PD(E) - Physical Disability over 65 Bushmead Court I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11/10/04 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 celings, 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 I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection and was carried out during one working day. The home was prepared for the inspection. The methodology used for this inspection included case tracking, direct observation, documents reading, collecting comments from staff and service users and a tour of the building. The inspector also used a pre-inspection questionnaire. What the service does well:
A revised “statement of purpose”, service user’s guide and the home’s brochure were used to provide information about the home to anyone who was interested in a residential care home. This pack is called the “Welcome introduction” and has information regarding the terms and conditions of the home. The admission to the home is arranged through several phases, so that all information is shared before any decisions are made. The home has just started using a new format for care plans, the service users knew about the care plans and said that they were asked their views when the plans were drawn up. The home has a very good relationship with the relatives, during the inspection, the Manager of the home, telephoned the family of a service user to inform them of the progress being made by their relative, who had recently been admitted to a hospital to let them know. The home has arranged for one GP to provide the care for the majority of the service users, if required, in order to ensure that they are regularly seen by a Doctor and by the other Health Care Professionals. A service user commented: “It’s not a five star hotel, but it is a very good place to be, I like how things are here.” The home has a training plan and programme; staff are up to date with their training. They are supervised regularly and discuss relevant topics at these formal sessions. The owner and the Manager jointly interview the new senior staff and the Manager alone interviews any new junior staff. The home had a particularly good quality assurance system. The service users commented: “…We are happy with these questionnaires; we have opportunity to say what we want to.” Staff also gave a very positive response regarding their positions and how they were treated: “We are treated equally, the owner comes in regularly and he
Bushmead Court I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 Page 6 always helps, he even assists with the cleaning”. “The staff atmosphere is good and we have enough staff”. The staff showed respect to the service users: “This is their home; they can stay in their rooms or come into the communal areas, whichever they prefer.” 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.
Bushmead Court I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bushmead Court I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Bushmead Court I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 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 standard(s) 1,3,4,5 The service users were able to make their own decisions to move into the home based on well prepared and given written information. The home assessed potential service users closely, to ensure that staff were able to meet their needs upon admission. EVIDENCE: The home had an appropriate “statement of purpose” and “service user’s guide” and reviews these documents regularly. The service users guide was a particularly well written document, where the content was described in plain English and was suitable for the service users. Terms and conditions of residence were described in a “Welcome introduction” pack. The home carries out comprehensive admission assessments and additionally, the documents regarding potential service users, are collected from external sources prior to admission. The Manager and staff said that the level of care needed for recently referred service users is greater now, as they have more varied health conditions. However, the level of care given is much higher now than in the past. The home collected information from relatives on the life histories of the service users, to ensure that all staff gets to know each individual and their needs well.
Bushmead Court I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 Page 10 The home offers a 4 week trial admission for the benefit of the service users and the home. This is based on exchanging information with the service users, relatives, external professionals and an introductory visit to the home. Bushmead Court I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 Page 11 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 standard(s) 7,8,9,10 Care plans were written using the new format, but did not provide full information. They did not relate necessarily to other documents and could not be used by the care staff effectively. Consequently, good care was offered based only on the staff’s personal knowledge of the service users. EVIDENCE: The initial written assessment was appropriate, after which the staff learnt the service user’s needs during their work with them. There were detailed records through the documents, but they did not relate clearly to each other. A care plan for a service user addressed various needs and how they would be met, but the risk assessment had included “aggression” which was not mentioned or addressed in the care plan in any way. The reviews of care plans were held monthly, and any new needs were added. However, the previous needs, that either were met or no longer relevant were not removed from the care plans. The home kept various charts for service users that demonstrated that their needs were met. These charts were acceptable, although did not always correspond to the care plans and risk assessments. Some personal belongings’ lists were not dated and signed by service users or their relatives.
Bushmead Court I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 Page 12 Medication records did not accurately corresponded to the amount of tablets present in the home. The recording system was not effective, as they do not allow easy monitoring and audit of medication. The amount of tablets inspected did not correspond to the records. A service user commented that “sometimes we don’t get our pills”. The existing recording system could not confirm or dismiss this claim and needed to be organised differently. The home respected privacy and dignity of service users. Some of them have private phones in their rooms, they were addressed by their preferred names and staff spoke to them with respect. Bushmead Court I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 Page 13 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 standard(s) 12-15 Various and stimulating activities organised in the home met service users needs. However, the standard of food and service of food was not as it used to be and the service users have noticed the difference. EVIDENCE: The home provides activities that include: Bingo, which is very popular, sing-alongs, creative games, reminiscence and visits by various church representatives. The home recorded service user’s preferences regarding activities, during their initial assessment and trial period and matched them with the provisions of the activities. The home established a very good relationship with many families of the service users and kept them informed and involved in the care process. For example, families were asked to provide information about the service users’ life histories, this was included in the service users’ file. Several service users had a small amount of money with them and the home’s policy stated that the home did not deal with users’ finances. An advocacy worker was expected to visit service users later that week to offer help with the identified need to manage her money. The home promoted independence of service users with appropriate risk assessments, but still allowing them to take reasonable risk in managing their finances. When this was not safe anymore, the home called an advocate, rather than exposing service users to unnecessary risk. The home exceeded the standard by implementing this financial procedure.
Bushmead Court I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 Page 14 The Majority of service users stated that the food was good and did not have any complaints. However, a service user spoken to commented that the home no longer used table cloths and she thought it would be nice to have cloths on the dining room tables again; two other service users supported this idea. The menus demonstrated that a well balanced and nutritional diet was offered. Bushmead Court I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 Page 15 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 standard(s) 16-18 The home had the procedures in place to protect service users. There were no complaints, but the knowledge of the procedure by service users provided reassurance that their safety and protection were ensured. EVIDENCE: The home had a clear and appropriate complaints procedure and it was displayed in the main hall. An advocacy worker was expected to visit the service users to ensure their rights could be exercised in an appropriate way. The manager demonstrated good knowledge of the Protection Of Vulnerable Adults (POVA) procedure, but there were no allegations and no one was referred to the POVA register. Bushmead Court I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19-26 The home was located in a grade II listed building in a desirable area and environmentally met the needs of service users. EVIDENCE: The premises were accessible, safe and well maintained. The home employs a maintenance man who deals with both minor and major maintenance issues. The garden was very attractive and well maintained, offering a pleasant outdoor space for service users. The home uses some garages just behind the building for extra storage space. The communal areas were pleasant, furnished in a domestic style with good quality furniture, some of which has an antique value, service users like this environment. Toilets and bathrooms are easily accessible and several service users use them independently. A library is also well used by service users. The home has the equipment and facilities to assist service users in maintaining their independence. The size of the bedrooms exceeds the national minimum standards. Two out of the three double bedrooms are used as singles and 20 of the rooms have en-suite facilities. The bedrooms are nicely furnished and equipped appropriately to meet the needs of service users.
Bushmead Court I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 Page 17 A downstairs bedroom has been allocated to a service user who benefits from the proximity of communal areas; this is so that she can maintain some independence. The home was clean and tidy and the infection control measures were in place. Bushmead Court I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27-30 The home employed sufficient number of skilled and committed staff that were able to respond to the needs of service users and ensure the good level of care was offered to each individual. EVIDENCE: The manager planned and deployed staff through an appropriate rota that ensured that enough and appropriate staff worked on each shift. The basic guide for determining the number of staff per shift were service users’ needs. Although the home offered good basic training, the low number of NVQ qualified staff had just been addressed and had resulted in 9 staff working towards the qualification. All new staff were inducted on TOPSS principles. Staff commented that the training offered to them was appropriate and sufficient. Training records demonstrated that mandatory training was up to date and that training was organised in a planned way. Staff’s files contained all relevant staff’s documents and only one file did not have a Criminal Records Bureau disclosure, but the manager showed that it had been applied for. Bushmead Court I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31-38 The home was managed in an open, creative and inclusive way and service users benefited from appropriate leadership. Both the manager and the owners were carrying out the management process and this meant that service users were not only well looked after, but also listened and protected. EVIDENCE: The manager was experienced and skilled. She knew the service users well, as individuals and had a good understanding of the conditions that affected their lives. She was registered since the last inspection with the registration authority. She established and created an inclusive and open atmosphere where both service users and staff felt empowered. The owner had introduced a quality assurance system that was used to monitor and improve the services. This system was specially adapted to suit the conditions of service users and allow them to accurately present their opinions. This system was very specific and exceeded the requirements to use a set system in order to get appropriate information. The sample
Bushmead Court I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 Page 20 questionnaires seen during the inspection demonstrated that even service users with sensory impairments could provide their comments on a sheets with large print. Service users knew about this programme and were pleased that their voice was heard. The home’s financial policy stated that no staff were involved in dealing with service users’ finances. An independent advocate was invited to offer extra support with finances to those that needed that support. Staff were regularly and appropriately supervised. Records were accurate, up to date, safe and accessible to appropriate people. Safe working practices were in place. Accidents/incidents were correctly recorded and families were informed appropriately. Bushmead Court I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 2
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 4 3 3 3 3 3 Bushmead Court I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 Page 22 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13 Requirement The home must have a safe and accurate medication procedure and records. Timescale for action 01/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 7 15 28 Good Practice Recommendations The care plans and other documents held in respect of each individual should correspond to each other and address clearly main areas of identified needs. The home should use a table cloths in a dining room to improve attractiveness of the food served. The home should encourage more staff to attend NVQ training in order to meet the 50 ratio of the NVQ trained staff. Bushmead Court I51 s14995 BUSHMEAD CRT v226720 310505 stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 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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