Inspection on 22/06/06 for Butlin House

This inspection was carried out on 22nd June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Butlin House 12/01/10

Butlin House 04/10/07

Butlin House 18/11/05

Butlin House 06/12/04

Butlin House 28/07/04

Butlin House 27/01/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Butlin House Beaverbrook Court Bletchley MILTON KEYNES Bucks MK3 7JS Lead Inspector Mr Guy Horwood Unannounced Inspection 22nd June 2006 08:45a 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 Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 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. Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Butlin House Address Beaverbrook Court Bletchley MILTON KEYNES Bucks MK3 7JS 01908 376049 01908 630534 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) Printers` Charitable Corporation Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 35 Service users Nursing Care 5 (five) beds dually registered Date of last inspection 18th November 2005 Brief Description of the Service: Butlin House is a purpose built care home owned by the Printers Charitable Corporation. It is set in a residential area, close to local shops and other amenities, and is served by local bus services. Milton Keynes is located a short distance away, where national rail and bus links are available. Butlin House can accommodate up to 40 elderly residents requiring care and nursing needs. Accommodation is provided over two floors, where all bedrooms are single occupancy with en-suite facilities. There are two communal bathrooms on the first floor and one on the ground floor – these contain disabled bathing facilities. A large lounge and dining room are situated on the ground floor, and a small lounge / quiet area is present on the first floor. The home has a shaft lift and a stair lift. A team of qualified nurses, carers, catering, housekeeping and maintenance staff supports the home’s manager. A qualified nurse is on duty 24 hours a day. Allied healthcare professionals are accessible through direct contact or by General Practitioner referral. Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the summary of the unannounced inspection carried out at Butlin House Care Home. The inspection was carried out over 2 days, the 22nd and 27th June 2006. The second day of the inspection was announced in order for the manager to be present. The lead inspector was Mr Guy Horwood. The inspector was able to meet with residents and staff members during the visit, and examined records pertaining to the provision of care and the running of the home. The visit included a tour of the building, including communal areas and some resident’s bedrooms. The inspector made an appointment to return to Butlin House on the 27th June, in order to meet with the homes manager, Mrs Penny Barkham. During this visit the inspector was able to feed back his findings from both days of the inspection to Mrs Barkham. Comment cards were distributed prior to the inspection to seek the views of those living at the home and of visitors to the home: - One comment card was returned from a resident. It stated that they liked living at Butlin House, they felt well cared for, were treated well and their privacy was respected. They stated that they were provided with appropriate activities, the food was nice and they felt safe. - Resident’s relatives returned two comment cards. Both expressed satisfaction with the numbers of staff on duty, visiting arrangements and the overall care provided at the home. - Comments received from the General Practitioner included that they were happy with the care provided, were able to liase with a senior member of staff when they visited, and felt communication with the home was satisfactory. - A comment card from a social worker involved with the home expressed overall satisfaction with the care provision of the home, and commented “There has been a marked improvement since the new manager took post”. Following a requirement served at the last inspection, the home has undertaken a process of quality assurance through seeking the views of residents and their representatives. The inspector viewed a selection of returned surveys, the majority of which rated the overall service provision as “Good”. Comments within these surveys included the following: - “The staff are always cheerful and kind”, - “Nursing staff are excellent…carers are kind and efficient” - “Some nurses and carers lack discipline that may come from who is in charge at that time”, - “Whole management of the home has improved since appointment of Penny Barkham”, - “Overall I am happy with mothers care”, Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 6 - “Much better staffing last 3 months”, - “Staff levels seem low some weekends”, During the tour of the premises, one residents spoken with commented, “I wouldn’t change anything about the place. I am very happy here.” During the inspection staff were polite and helpful, and the inspector would like to thank them for their co-operation and assistance. The inspector would especially like to thank the residents for their time and for allowing the inspector into their home. What the service does well: What has improved since the last inspection? What they could do better: Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 7 Care plans need to be complete, detailed and holistic, and provide staff with information as to how individual residents personal, health and social care needs are to be met. Care plans need to be maintained, up to date, and subject to a process of regular and meaningful review. Where an irregularity is noted in a residents health, ( e.g., vital signs, weight, tissue viability, blood sugar level etc), staff must take appropriate steps to review the care provided and ensure the residents well being. Staff must be prompt in contacting relevant healthcare professionals where they identify a need to do so. Staff must be consistent in completing food / fluid charts where they are used. Medicine charts must be completed and accurate. More vigilance is needed with regard to the safe storage of COSHH substances. It is recommended that risk assessments are undertaken with regard to the use of free standing heaters in bedrooms. It is recommended that training for staff to care for people with dementia type illnesses is included in the homes training schedule. Fire safety training and training updates should recommence. 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. Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 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 Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 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): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Pre-admission assessments of potential residents are conducted, and the assessment viewed held good detail giving staff the information they needed to formulate an initial care plan and hence provide appropriate care for the individual from the outset. Intermediate care is not provided at this service. EVIDENCE: Potential residents are visited and assessed by the homes manager, with a record of these assessment visits kept. A pre-admission assessment record for a recently admitted resident was viewed. The assessment held good detail and concluding comments as to what the individuals care needs were to be. It is recommended that the assessment process could be improved further by obtaining details as to an individual’s susceptibility to developing pressure ulcers and their moving and handling needs including a falls risk assessment. Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 10 The template used to record these assessments has sufficient scope to include more detail with regards to these areas. Intermediate care is not provided at Butlin House. Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some individual residents specific care plans lacked detail and do not provide sufficient information to enable someone unfamiliar with a residents care needs to care for them. As a result residents health and social care needs may not be fully identified and met. Residents have access to healthcare professionals external to the home, although improvement must be made in reacting to changes identified in resident’s health and in accessing external healthcare professionals promptly. A failure to improve in this area may lead to resident’s healthcare needs not being met. In the majority of cases medication is recorded, stored, and administered safely, and residents receive their medication as prescribed. However, improvements are required in the management of medication records and of resident’s health care needs where they persistently refuse prescribed medicines. Observation and comments made at the time of the inspection provide evidence that residents are afforded with privacy, dignity and respect. Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 12 EVIDENCE: Residents, including those seen in bed, appeared clean and comfortable and to be dressed in appropriate attire. Glasses appeared clean, hair to have been brushed, and in most cases nails were clean and had been trimmed. A selection of resident’s files were viewed, including some for the purposes of tracking selected individual’s care. These files are required in order to set out the identified care needs of the individual resident and the actions required by staff in order to meet these care needs. The files viewed included assessments as to the residents risk of falls, nutritional status, moving and handling needs, risk of developing pressure ulcers, family and social history, and funeral arrangements. In those files viewed, a number of assessments were either blank or not fully completed, and failed to provide sufficient detail as to what the care needs were and how they were to be met. The care files contain a care plan, where specific care needs are identified and an action plan is formulated for staff to meet these needs. Areas of care covered within those care plans viewed included “Minimising the risk of developing pressure sores”, “Catheter care”, “Wound care”, “Pain”, Hygiene”, “Mobility”. These were pre-printed care plans, where details, such as the resident’s name, were added. Use of pre-printed care plans need to incorporate enough individual detail to give staff sufficient information to provide appropriate care. It was felt there could be improvements in this area as evidenced by: - “Minimising the risk of developing pressure sores” – there were no details included as to turning regimes, pressure relieving mattress settings, reference to a tissue viability assessment tool, and nothing about the residents current condition. - “Catheter care” – this mentioned weekly urine testing, but there were no records to show this was actually happening. - “Pain and the aim for Mrs X to be pain free at night / day / mobilising” –there was nothing mentioned as to whether the resident had any pain, and if so where / when / why and nothing to say what was working to address Mrs X’s pain. - “Hygiene” – no details mentioned as to what the resident can manage independently or what level of assistance is required. Improvements also need to be made with the content of the evaluation sheets to ensure changes or otherwise, and necessary actions following the evaluation, are recorded. It was noted that one individual nurse consistently included specific details pertinent to the individual resident within this section Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 13 that would be more beneficial if incorporated into the actual care plan. This was discussed with the manager. Where tissue viability assessments recorded an increase in risk, no evidence was present as to a change in the care plan. Likewise, where a loss in weight was noted there were no significant changes to the care plan, although it was evident in one instance that staff had commenced with recording food and fluid intake and that the nursing record held relevant comments. Moving and handling assessments held little detail as to what equipment should be used in relation to specific transfers / movements. Records of daily activities provided at the home are kept at the back of individual care plans. One care plan viewed included a resident’s family tree and some details as to their personal interests and background. This is good practice and should be developed for all residents. Records pertaining to visits by healthcare professionals were satisfactory, although in one instance a delay in contacting the General Practitioner with regards to an injury to a resident was noted to be commented on by the General Practitioner themselves. Records were evident to show that resident’s weights and vital signs are monitored monthly. Diabetic residents blood sugar levels are recorded consistently at 7am and 5pm. It is recommended that some variation be included within the times of monitoring. It was noted that where blood sugar levels were recorded as high, particularly in the evenings, no further monitoring took place - despite this high reading usually coinciding with meals and the administration of insulin. A number of food and fluid intake charts were viewed for specific residents. The level of information and consistency in completing these charts varied, with food charts for those residents identified as losing weight completed to a satisfactory standard, but some fluid charts holding very little detail. The pre inspection questionnaire completed by the manager stated that 3 residents had a diagnosis of dementia. It is recommended that training for staff in how to care for people with dementia type illnesses is included in the homes annual training programme. At the time of the inspection medicines were stored securely and appropriately, and did not appear over stocked. Controlled drugs were accounted for and are checked on a regular daily basis. Medication Administration records were viewed. Within these records gaps were noted; prescribed medicines had been omitted with no explanation recorded; charts were not signed where medicines had been delivered from the pharmacy; there was no evidence of discussion Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 14 with the General Practitioner with regards to residents persistent refusal of prescribed medicines. In some instances staff had hand written instructions within charts as to the administration of prescribed medicines, including controlled drugs. Where this had occurred, staff stated that the directions were copied from the prescribed medicines packaging and 2 staff members had signed the chart. It is recommended that evidence of the original prescription be held with hand written charts, and that instructions for the administration of controlled drugs only be entered by the General Practitioner. When discussed with the manager, the inspector was informed that the home is currently in the process of changing medication systems. Staff were noted to knock at doors before entering, closed doors and curtains when providing personal care, and were polite and friendly when speaking with residents. Assistance with drinks and meals, where observed, was unhurried, sensitive and discreet. Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 15 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): 12,13,14,15. Quality in this outcome area is good. This judgement has been made from evidence gathered during the inspection, which included a visit to the service. Residents are able to receive visitors at times of their choosing, receive a choice of meals, are provided with entertainments and activities in groups and as individuals, and have contact with local community groups. Residents are therefore presented with choice within everyday routines, are able to maintain relationships with families and friends and receive a variety of stimulating activities and entertainments. Staff are sensitive, polite and unhurried where assisting residents with meals. Meals and drinks are of a good standard; incorporate relevant dietary needs; and therefore provide residents with appealing meals and meal choices. EVIDENCE: An activities organiser is employed for 31 hours per week. At the time of the inspection posters were displayed advertising a clothes sale, visiting entertainer and barbecue. A notice board in the main corridor listed planned activities for the month of June. The activities organiser stated that she provides group activities, (such as games, showing films, quizzes), and one-to-one time, (reading, chatting). Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 16 Fund raising takes place, with all funds held by the manager with records kept. These records were not viewed at the time of the inspection. A local school visits during the year to entertain residents, and local religious leaders visit occasionally. The home has open visiting, and at the time of the inspection several relatives were seen to visit. Residents confirmed that they receive visitors when they choose, and one stated that he is able to go out when he chooses in a powered wheelchair to attend a social club and church services. A number of residents were noted to have telephones in their bedrooms, and one to possess a computer. This enables residents to maintain contact with friends and family. The resident who has a computer has chosen to be responsible for developing and producing a newsletter for the home. This provides information as to up and coming entertainments, and reports on past events and celebrations. Back copies of these newsletters were viewed, and indicated a number of events, celebrations and entertainments held at the home. The resident takes great pleasure and satisfaction from this work. It is an example of the home encouraging and facilitating a residents hobbies and interests to the benefit of many. The Printers’ Charitable Corporation provides Funding and support and they are commended for this. For part of the morning staff had a radio in the lounge area tuned into a “pop” music channel. It is debatable as to whether this was at the request of residents. The homes menus are displayed for residents, include seasonal variation and present a choice of meals. The majority of residents took lunch at dining tables in the spacious dining room, and this meal appeared a sociable event, with lots of interaction and conversation between residents, staff and some visitors – who took lunch with their relatives. Where staff assisted residents with their meals, this was done sitting down and in a discreet and sensitive manner. Residents were able to dictate the size of their lunch due to staff serving them the vegetables. Residents commented that meals were good, and that lunch on the day of the inspection was of the usual standard. The days lunch was sampled, (Braised beef, cabbage, mashed potato, carrots.), and was found to be tasty and well presented. All residents had drinks provided with their meals. The kitchen was toured, and the cook was met. The kitchen was clean and tidy, especially given that lunch was being prepared. Food storage appeared orderly and appropriate. The quality of foodstuffs appeared of a satisfactory standard, with a good proportion of fresh vegetables and fruit. Records required in respect of food storage and service appeared orderly, and there had been an Environmental Health Officer visit in the preceding 3 month Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 17 period. The cook stated that the small number of recommendations from the EHO visit had been attended to. Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 18 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. Quality in this outcome area is good. This judgement has been made from evidence gathered during the inspection, which included a visit to the service. The home has a complaints procedure for residents and their representatives, which enables them to express their concerns and expect a structured response. The home holds policies and procedures in relation to the Protection of Vulnerable Adults, Care staff have received relevant training with regards to identifying and reporting abuse, and the homes recruitment procedures are satisfactory. These measures safeguard residents. EVIDENCE: The homes complaints procedure is displayed in the home, and is accessible to residents and visitors. The complaints log was viewed and it was confirmed that the manager has received no complaints in the preceding 3 months. The Commission has not received any complaints directly with regards to the home. Those recruitment files viewed appeared orderly and to hold references and Criminal Record Bureau checks prior to staff starting work at the home. The home possesses organisational policies relating to identifying and reporting abuse, as well as copies of the local interagency policy relating to this topic. Leaflets pertaining to the local interagency policy are displayed in the nurse’s Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 19 office for staff members to access. Staff receive training in the Protection of Vulnerable Adults. Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 20 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): 19,26. Quality in this outcome area is good. This judgement has been made from evidence gathered during the inspection, which included a visit to the service. The provision of suitable furnishings, undertaking of a programme of maintenance and the standards of cleanliness apparent at the time of inspection, provide a pleasant and homely environment for residents to live in. There were some oversights with regard to health and safety, which needs addressing to ensure Butlin House, provides a safe environment for residents, staff and visitors. EVIDENCE: At the time of the visit the homes gardens and borders appeared well tended and were very pleasant to behold. The person responsible for maintaining the gardens is to be commended on providing an attractive setting where residents can sit outside or view from the windows. The front door is secure, and visitors to the home have to be allowed in by staff. Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 21 The inspector toured the home, this included visiting the kitchen, communal areas and a random selection of residents bedrooms. The home has a spacious dining room and adjoining lounge on the ground floor, and a very small lounge on the first floor. All bedrooms have en-suite facilities, comprising of toilet, washbasins and showers. Grab rails and raised toilet seats were evident where required. The internal layout of the home is suitable for its stated purpose. It is maintained to a satisfactory standard and on the whole possesses suitable furnishings and presents a homely atmosphere. At the time of the inspection the home was clean and tidy, and other than an isolated room, was free from unpleasant odours. At the time of the visit, housekeeping staff were working hard to maintain this appearance. A very small number of areas were identified as requiring attention, these are listed below: - Room 40: Strong and unpleasant odour, possibly from carpet. If unable to address through cleaning, carpet to be replaced. - Room 40: Tears to the material of the armchair and recliner chair. These chairs need replacing. - Room 38: Carpet stained and worn. This carpet is in need of replacement. As identified at previous inspections, some of the homes bathrooms, although large and clean, lack personal touches and appear quite clinical. This is not in keeping with the overall “homely” appearance of Butlin House. During the tour of the premises some health and safety risks were noted: - Housekeeping staff left a bucket of chemicals unattended in a corridor for a long period of time. It is acknowledged that the sudden illness of the staff member using these chemicals led to the oversight. A number of residents were being cared for in bed and bed rails were in place. Bed rail protectors need to be provided following a needs assessment. - Supplementary heating was noted in some rooms in the form of freestanding electric heaters. Risk assessments on the use of such heaters need to be in place. Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. At the time of the inspection the home was staffed with a sufficient number of care staff to meet personal and healthcare needs. The homes recruitment policies and procedures protect residents. Staff are provided with the opportunity to undertake appropriate training in order to meet resident’s personal, health and social care needs. More emphasis needs to be placed on ensuring all staff have undertaken training pertaining to health and safety to minimise risk to themselves and the residents they care for. EVIDENCE: At the time of the inspection the home appeared to be staffed sufficiently to meet residents needs, with all residents appearing to be washed and dressed by a suitable time. The staff team consisted of qualified nurses, carers, administrative, maintenance, catering and housekeeping staff. In the absence of the homes manager on the first day of the inspection the home appeared to be running smoothly, with staff interacting appropriately. Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 23 The staffing rosters were viewed. These appeared clear and easy to interpret, with alterations easily identifiable. On the first day of the inspection, for 28 residents accommodated at the home, 3 registered nurses and 7 carers were on the early shift, and 2 nurses and 5 carers were on the afternoon shift. The nurse in charge of organising the rotas stated that if the number accommodated rose above 30, the rotas could be reviewed and staff numbers increased by 1 carer per shift. The recruitment files for 3 recently appointed staff members were viewed, as were the Criminal Record Bureau and PoVA checks, which are held separately. These appeared satisfactory and to hold the required documentation. A number of files holding records and certificates of staff training were viewed. It was evident that certain staff had received training in a number of topics, including food hygiene, the Protection of Vulnerable Adults, moving and handling and wound care. The inspector did note within recruitment files that new staff had attended the ONTRACK Course run by Milton Keynes Council Only one staff member appeared to have received fire safety training in the 12 months prior to the day of inspection. The manager, when spoken with, stated that fire safety training is planned for the near future. The manager was informed that a requirement is to be made for all staff to receive this training as a matter of urgency. The manager is reminded to ensure all staff undergoes mandatory training with updates as necessary and that records of this training are kept for inspection purposes. Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 24 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): 31,33,35,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is managed by a suitably experienced person, Mrs Barkham, who presents as a suitable role model for staff to follow. Some areas of staff performance have been identified as requiring improvement to ensure residents care needs are met. A process of seeking the views of residents and their representatives has commenced in order to ensure that the home is run in the best interests of the residents. Health and safety procedures and practice need to be more robust to minimise risk. EVIDENCE: Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 25 The homes manager, Mrs Penny Barkham, was not present for the first day of the inspection. In order to cover certain standards and so as to be able to feed back the inspectors findings, a second day was arranged for the inspector to return to the home to meet with Mrs Barkham. Following a requirement served at the last inspection, the home has undertaken a process of quality assurance through seeking the views of residents and their representatives. This has taken place 3 times since the last inspection, (December ’05, January ’06 and June ’06), with surveys sent out to residents and / or their relatives. A number of the returned survey sheets were viewed, with a number of complimentary comments noted, as well as some points for improvement. The manager stated that she has taken on board the comments requiring attention and evidenced that she is looking to attend to these issues. The manager is currently in the process of reviewing systems in place for handling resident’s personal money, and provided evidence of this. The new system will be with a named high street bank and will include individual interest earning accounts providing regular statements. This provision will be reviewed at the next inspection. At the time of the inspection a number of issues were noted with regards to failures in health and safety: - Housekeeping staff left a bucket of chemicals unattended in a corridor for a long period of time. - A number of residents were still being cared for in bed when the inspection began. Bed rails were fitted to these beds, however a number of these bed rails did not have protective covers. - Supplementary heating was noted in some rooms in the form of freestanding electric heaters. No risk assessments were in place for these. - Fridge temperatures in the kitchenette on the first floor had been recorded at between 9°C and 12°C for a considerable period of time, (It is recommended that fridge temperatures be usually 5°C, but at least below 8°C). The kitchen was clean and tidy, especially given that lunch was being prepared. Food storage appeared orderly and appropriate, and hazard analysis records were satisfactory. Records required in respect of food storage and service appeared orderly, and there had been an Environmental Health Officer visit in the preceding 3-month period. The cook stated that the small number of recommendations from the EHO visit had been attended to. A number of service and maintenance records were viewed pertaining to equipment, including hoists and stair lifts, and systems including fire detection and call bells. These were in order and were up to date. A test of the fire alarm system took place on the day of the inspection, with staff and visitors Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 26 being warned in advance. Accident records were viewed and appeared satisfactory. Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 27 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 1 Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 13(2) Requirement Timescale for action 01/08/06 2 OP7 15 3 OP8 12(1) The manager is required to monitor the medication administration sheets to ensure correct procedures are followed when staff administer medications including signing the charts. Previous timescale 01/12/05 not met. Care plans must be complete, 01/10/06 detailed and holistic, and direct staff how residents care needs are to be met. Care plans must be up to date, maintained and subject to a process of meaningful review. Where an irregularity is noted in 01/08/06 a residents baseline observations or regular assessments, (e.g., weight, tissue viability, blood sugar levels), or their health and / or welfare, staff must not compromise the residents wellbeing through failing to act appropriately and promptly, must review and alter the care plan to a satisfactory standard, and where appropriate must contact external healthcare professionals promptly. DS0000042542.V288702.R01.S.doc Version 5.1 Butlin House Page 29 4 OP30 18(1), 13(4) 13(4) 13(4) 5 6 OP38 OP38 7 OP38 13(4) 8 OP38 13(4) All staff must receive mandatory training in fire safety. This training is to be provided on an annual basis. Chemicals are to be handled safely and stored securely, as per relevant guidelines. Risk assessments are to be undertaken for the use of freestanding supplementary heaters. Where bed rails are used on resident’s beds, a risk assessment should be carried out to determine whether protectors are necessary. Fridge temperatures must be maintained at below 8°C and are strongly recommended to be maintained at 5°C. 01/09/06 01/08/06 01/08/06 01/08/06 01/08/06 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 OP3 OP8 OP9 Good Practice Recommendations It is strongly recommended that more specific detail be recorded within pre-admission assessments. It is recommended that some variation be included within the times of monitoring blood sugar levels. It is recommended that evidence of the original prescription be held with hand written charts, and that instructions for the administration of controlled drugs only be entered by the General Practitioner. It is strongly recommended that freestanding supplementary heaters are not used within the home. It is recommended that training in how to care for people with dementia type illnesses is included in the homes annual training plan. It is recommended that a regular programme of monitoring the functioning of window restrictors is put in place with records of this monitoring available for DS0000042542.V288702.R01.S.doc Version 5.1 Page 30 4 5 6 OP38 OP30 OP38 Butlin House inspection purposes. Butlin House DS0000042542.V288702.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 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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