Inspection on 10/06/08 for Elstree Lawns Nursing Home

This inspection was carried out on 10th June 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Elstree Lawns Nursing Home 27/11/07

Elstree Lawns Nursing Home 26/04/07

Elstree Lawns Nursing Home 30/01/07

Elstree Lawns Nursing Home 26/07/06

Elstree Lawns Nursing Home 01/11/05

Elstree Lawns Nursing Home 21/12/04

Elstree Lawns Nursing Home 30/06/04

Similar services:

Claremont House

Firstlings

Fen Road

Dial House Nursing Home

Croxley House

Eversley Nursing Home

Cresta Lodge

Chilton Meadows Residential & Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Elstree Lawns Nursing Home Barnet Lane Elstree Hertfordshire WD6 3RD Lead Inspector Claire Farrier Unannounced Inspection 12:30 10 and 11th June 2008 th 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 DS0000019344.V366250.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000019344.V366250.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elstree Lawns Nursing Home Address Barnet Lane Elstree Hertfordshire WD6 3RD 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) 0208 207 3255/3271 0208 207 1149 www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd Manager post vacant Care Home 54 Category(ies) of Dementia - over 65 years of age (54) registration, with number of places DS0000019344.V366250.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home may accommodate people (aged 50 or over) with a diagnosis of pre-senile dementia who require nursing care. 26th April 2007 Date of last inspection Brief Description of the Service: Elstree Lawns Care Home is sited in a large, three-storey building, which has been converted and extended to provide nursing care for people who have a diagnosis of dementia. The top floor of the building is no longer used for accommodation. All bedrooms are for single occupancy and 29 have en-suite facilities. The home is reached at the end of a long, secluded driveway and there is ample parking available in front of the building. There are gardens and patio areas to the rear of the home and these have been modified for the safe use of the residents. The home is set back from a busy road and is near to the village of Elstree and the town of Borehamwood. Facilities for shopping and leisure are within a short drive and there is a nearby bus service. The current accommodation charges ranged from £550 to £900 (£1000 for respite) per week in December 2007. Current fees are available from the home. A copy of the homes most recent CSCI inspection report, Service User Guide and Statement of Purpose is displayed in the foyer of the home. DS0000019344.V366250.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. On 15th January 2008 the CSCI Pharmacist inspector carried out an inspection of the administration, recording and storage of medication in the home. He found that residents are protected by having clear and detailed medicine handling procedures that were available to the care staff, but these are not always followed. On 15th April 2008 we visited the home to review the requirements made following the last key inspection, for which the compliance date had past. We found a great deal of improvement in the quality of care provided in the home. The outcomes of theses visits have been included in this report, and the full reports of these visits are available on request. For this inspection we spent one afternoon and the following morning at Elstree Lawns, and the people who live there and work there did not know that we were coming. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. We talked to as many of the people who live in the home as we were able to and we also spoke to some of the staff. We spent two hours sitting with people in the area of the home where the most vulnerable people are looked after. The aim of this was to get an impression of what life is like for the people who live there. Three people in particular were observed and their care was tracked. Four people completed Have Your Say surveys before the inspection. One relative completed the survey on behalf of the resident, and we received one response from a health professional. We have used the information from these in this report. The manager sent some information (the Annual Quality Assurance Assessment, or AQAA) about the home to CSCI before the inspection, and her assessment of what the service does in each area. Evidence from the AQAA has been included in this report. We have also looked at the reports of the visits that the BUPA Regional Manager makes to the home. When we were in the home we looked at the home’s records, care plans and staff files, and we made a tour of the premises. We talked to the manager and the Regional Manager about what we had seen during our visit. DS0000019344.V366250.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The manager sent us an action plan after our visit to the home in April 2008. This showed that the home had taken appropriate actions to meet all the requirements that were made in the last inspection report. When we visited the home in April we noticed a great improvement in the care and consideration that the staff gave to the people in the home. On both floors of the home we were impressed with the way that all the staff interacted with the people who live in the home. Every member of staff that we observed, care staff, nurses, housekeepers and activities co-ordinators, had a very good relationship with the residents. They understand what each person needs and how to assist them, and they treat them with courtesy and kindness. This improvement has been maintained, and on this occasion we were again impressed by the attitude of the staff, and the understanding that they showed DS0000019344.V366250.R01.S.doc Version 5.2 Page 7 of each person’s individual needs. The staff confirmed that they have had training in dementia care and in moving and handling. Appropriate hoists are in place for people who need them. For people who are unable to use the nurse call bell when they are in their rooms, there is a risk assessment with a management plan of monitoring the person every hour. The new manager has carried out an audit of all the care plans and of the medication records in the home, and these have improved considerably. The Annual Quality Assurance Assessment (AQAA) states that residents and relatives are involved in planning their care. We spoke to some visiting relatives with one of the residents. They are generally very pleased with the care that they receive. They have been able to discuss concerns with the manager, and they are happy that changes are happening for them as a result of this. When we visited the home in April the carpet in the lounge on the first floor had been changed, and this is now a plain colour, which is more suitable for people with dementia. A stair lift had been installed on the steps between the lounge and dining room on the first floor. The home’s action plan stated that bedroom doors are not locked unless a resident is in hospital. This means that people have unrestricted access to their rooms at all times. An area on the first floor has been redecorated and furnished as a traditional pub, and a room has been refurbished as a typical 1950’s kitchen. What they could do better: Some further work is needed to make sure that all the care plans are up to date and provide clear information on each person’s needs. The monitoring of people with poor nutrition could be improved. The manager recognises that further improvements are needed, and in the AQAA said, “We could do better in person centred entries in daily records, and in consistent standardised documentation.” Some of the medication procedures need to be reviewed to make sure that there is not a risk of people having incorrect doses of medication. One person frequently refuses their medication, and it is therefore given to them ‘disguised’ in a sandwich. The consent form does not take the person’s capacity for making his or her own decisions into account, in accordance with the Mental Capacity Act (2006). Further changes could be made to make the environment more suitable for people with dementia. This includes further differentiation of different areas, for example by the use of colour, textures or themes, so that people can identify different areas more easily. The garden is well used as a seating area, but half of it is under used, or unused. The design and best use of this could be investigated to make it a positive area for everyone in the home to use. DS0000019344.V366250.R01.S.doc Version 5.2 Page 8 We are confident that the improvements that have already taken place in the home will continue. The manager has plans in place to ensure that there is a positive outcome, to continue to provide a good quality of life for the people who live in the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000019344.V366250.R01.S.doc Version 5.2 Page 9 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 DS0000019344.V366250.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has sufficient information on residents’ needs and access to appropriate services to enable their needs to be met. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) states that all prospective residents undergo a pre-admission assessment to ensure the home can meet any identified need and the placement will be appropriate. We looked at the files of two people who moved into the home during the last year. Both files contained assessments with good details of the person’s personal and health care needs, which were used to write their care plan. BUPA monitors the effectiveness of the assessments by visits from a ‘mystery shopper’. DS0000019344.V366250.R01.S.doc Version 5.2 Page 11 During our visit to the home in April 2008 we looked at the information that the home provides to people who make enquiries about their services. The brochure with information about the home had not been changed as required in the last inspection report, but the home now provides appropriate services for people with dementia, as described in the brochure. When we looked at care plans on this occasion we noticed that three people did not have a diagnosis of dementia. As the home is registered only for dementia care, everyone who is admitted to the home should have a diagnosis of dementia. Following the inspection the manager checked all the information that the home has for these three people, and confirmed that in the past they have all had a diagnosis of dementia. This means that the home is able to provide services that meet their needs. One survey that was completed for this inspection by a relative on behalf of a resident confirmed that they did receive enough information about the home before they moved in so they could decide if it was the right place for them. The staff have the experience, training and support to meet the needs of the people who live in the home. The staff who we spoke to confirmed that they have had training in dementia care. We saw the effects of this in their attitude to and relationship with the people they care for, and in the improved staff morale and confidence. (See also Staffing.) DS0000019344.V366250.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live in the home are confident that they will receive a good quality of personal care and healthcare. The care plans provide good information so that the staff know how to meet each person’s needs. However, the procedures for recording information in the care plans and for administering medication need further improvement. This will make sure that everyone has the care and medication that they need in a safe and effective way. EVIDENCE: When we visited the home in April we noticed a great improvement in the care and consideration that the staff gave to the people in the home. On both floors of the home we were impressed with the way that all the staff interacted with the people who live in the home. Every member of staff that we observed, care staff, nurses, housekeepers and activities co-ordinators, had a very good relationship with the residents. They understood what each person needs and DS0000019344.V366250.R01.S.doc Version 5.2 Page 13 how to assist them, and they treat them with courtesy and kindness. All the residents were dressed in clean, smart clothes, and looked well cared for. Tissues were offered to one person who had a runny nose. On the ground floor everyone was alert and engaged with everyone who spoke to them. Two people spent some time asleep, but woke and were alert and interested when they were given tea and cake during the morning. One person was sad and a little tearful. They were given appropriate attention, including cuddles. The staff said that they missed their spouse. There were two albums in the lounge that they liked to look at, one with pictures of their garden, and one with original postcards of places they visited with their spouse. They also relaxed and looked much happier while they enjoyed their tea and cake. This improvement has been maintained, and on this occasion we were again impressed by the attitude of the staff, and the understanding that they showed of each person’s individual needs. We spent some time sitting with people in the area of the home where the most vulnerable people are looked after. The aim of this was to get an impression of what life is like for the people who live there. There was a lovely interaction between the staff and residents. The staff took time to give each person individual attention. One person seemed anxious, and a nurse spent over half an hour with them, talking to them and massaging their hands and arms with hand cream. Following this, the person was more relaxed and more interested in picking items up and looking at them with interest, even when no one was with them. Another person seemed to be sleeping, but the staff said that they always sit with their eyes closed. The nurse spent an hour with them at supper time, talking to them, stroking their hand, and encouraging them to eat and drink. During this time one nurse was in the room all the time, and we observed her more than other staff. However throughout the day, and during our visit in April, we saw similar actions and care given by other members of the staff. Everyone was dressed in clean, smart clothes, and looked well cared for. However we saw one person wearing spectacles with their name written in large letters on the frame. It was reported that this was placed there by the optician, and would be removed. We were concerned about the home’s management of people with chest infections. In one week in January three people were admitted to hospital and died from recurrent chest infections. This was before the current manager was in the home. In April one person currently had a chest infection. They were seen by the GP, who prescribed antibiotics and oxygen. We saw the nurse offering them oxygen during our visit, and giving medication to them. We also looked at the care plan for a person who has pressure sores. The treatment and care provided was fully recorded, and included details of the equipment and mattress that were in place, and a turning chart to ensure that the person was turned regularly as stated in the care plan. The whole care plan was very detailed and up to date. It included the person’s wishes and preferences. We noticed that music was playing in this person’s room, as recorded as a preference in the care plan. On this occasion the care plans we saw confirmed that the monitoring of skin care and pressure sores has been maintained. One DS0000019344.V366250.R01.S.doc Version 5.2 Page 14 example that we saw clearly documented improvements in the person’s skin condition. It also contained a clearly written care plan for managing pain when changing dressings. This inspection took place on a hot summer day. Everyone was offered frequent drinks through the day, and those who needed help were encouraged and assisted to drink them. The staff made sure that people were not sitting in direct sunlight, and fans were in place to provide cool air where possible. The home has a good relationship with other professionals. The visiting GP monitors everyone’s health needs, and will make other referrals if they are appropriate, for example for mental health assessments and advice. A visiting optician completed a survey for the inspection, and said, “At times I inform the home due to observations while treating the residents, of further or future treatments required. They comply well!!” The Primary Care Trust Moving and Handling Advisor has carried out two assessments at the home since the last key inspection. Continuing concerns included: Poor moving and handling practice, incorrect equipment such a slings being used, and equipment not working or faulty. She felt that the culture was one of poor practice that needed to be challenged at every level. She has also visited the home to give some guidance and advice to the staff. There has been a rolling programme of moving and handling training since the last inspection. All the staff have now completed this training, and the staff who we spoke to said that their knowledge and practice has improved. Their practice is also improved by having appropriate equipment in the hone. The home has two Trixie hoists, one on each floor, and a standing hoist. A stair lift has been installed on the steps between the lounge and dining room on the first floor. We saw the staff using this appropriately, and they said that it has made the task of moving people from room to room much easier. We looked in detail at the files of five people who live in the home. The care plans are generally well written, with good details of each person’s personal care needs and healthcare needs. They are clearly written and generally use language that shows respect for each person. For example, using terms such as ‘walking’ instead of ‘wandering’. One care plan states, “X occasionally walks in the home, but X had no attempts to leave the place. Staff continue to ask them if they need any help in case they walk around.” A previous risk assessment for this person referred to them as ‘absconding’. The current care plan shows a clearer understanding of their motivation and how to assist them. This person tends to sleep in a chair in the lounge, because they are not happy to sleep in their room. The care plan states that they do not like white sheets on the bed, and these should not be used. However when we looked in the room during the inspection, there were white sheets on the bed. Appropriate risk assessments are in place, for most people. For people who are unable to use the nurse call bell when they are in their rooms, there is a risk assessment with a management plan of monitoring the person every hour. This is recorded, to show that each person has been seen every hour when they are DS0000019344.V366250.R01.S.doc Version 5.2 Page 15 in their bedrooms. Some risk assessments need further review to make sure that they still meet each person’s needs. The Annual Quality Assurance Assessment (AQAA) states that residents and relatives are involved in planning their care. We spoke to some visiting relatives with one of the residents. They are generally very pleased with the care that received. They have been able to discuss concerns with the manager, and they are happy that changes are happening for them as a result of this. Some further work is needed to make sure that all the care plans are up to date and provide clear information on each person’s needs. One person is reluctant to accept help with their personal care. The recording of the care that they receives could be improved, to show more clearly when they declined help, and how long it took to encourage them to accept the help to maintain their personal hygiene. The monitoring of people with poor nutrition could be improved. Everyone is weighed regularly, and if they loose weight they are referred to the GP and their food and fluid intake is monitored. However the file where these records are kept is untidy, and the current records for one person could not be found. One person has a care plan that states they should have pureed food. But the daily records for the day before this inspection stated, “Assisted to bed after a cup of tea and a sandwich.” The daily record has statements such as, “Eating and drinking adequate amounts,” “Eating and drinking poorly.” But without accurate records of what and how much they ate and drank, this information is inadequate to monitor the person’s wellbeing. The manager recognises that further improvements are needed, and in the AQAA said, “We could do better in person centred entries in daily records, and in consistent standardised documentation.” In January the CSCI Pharmacist inspector carried out an inspection of the administration, recording and storage of medication in the home. He found that residents are protected by having clear and detailed medicine handling procedures that were available to the care staff, but these are not always followed. Records were kept when medication was given to residents. However there were some problems with these records. Residents had their medication given to them by designated trained care staff. Additional training was provided following this inspection. The manager has been auditing all the medication records and practices. On this occasion we observed the staff administering medication on the first floor. The nurse followed the proper procedures for giving people their medication and recording it. However some procedures need to be reviewed to make sure that there is now risk of people having incorrect doses of medication. One person frequently refuses their medication, and it is therefore given to them ‘disguised’ in a sandwich. There is a consent form in the medication file, dated April 2006 and signed by the GP and the person’s relative. However this does not state the protocol for how the medicines should be disguised, and does not detail the specific medicines and whether each can safely be given in this way. The consent form does not take DS0000019344.V366250.R01.S.doc Version 5.2 Page 16 the person’s capacity for making his or her own decisions into account, in accordance with the Mental Capacity Act (2006). One person has medication for Parkinson’s disease, but there is no clear information whether this should be given at regular intervals throughout the day in order to be most effective. We checked the records for medication on the ground floor. We saw two examples of PRN (when required) medication being given, but the reasons for giving it each time were not recorded. The records of controlled drugs are audited regularly to make sure that they have been administered properly. On the day before this inspection there was only one signature on the controlled drugs record. Good practice is that two people should sign the record to confirm that the correct dose of medication has been administered. DS0000019344.V366250.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home have a choice of individual and group activities during the day that meets their needs and expectations. EVIDENCE: When we visited the home in April we noticed a great improvement in the activities available in the home. There were two activity co-ordinators in the home, but the practice had developed that every member of staff was involved in interacting with the people in the home. There was a weekly programme of scheduled activities, but these were flexible, and may be changed depending on the weather or what people want to do. There was an outing every week, using the adapted Barbara bus. While we were in the home, one of the activities co-ordinators took six people, from both floors into the garden. She played the guitar and they sang along or listened to the songs. Some used tambourines to join in. There were newspapers and books for them to look at, and they had tea and snacks. One person said that some of them had had a meeting to decide on seeds to buy for the garden. They and some others enjoy DS0000019344.V366250.R01.S.doc Version 5.2 Page 18 gardening. There was a daily record sheet on each floor, and anyone, including care staff, nurses and housekeepers, who had an interaction with one of the residents, recorded it. This may be talking to them, walking with them, reading with them, hand massage, etc. On the ground floor, one person’s daughter brought in a video of an army band and dog handling. Several people enjoyed watching this. When it was finished, one of the staff asked whether people would like some music. He danced with one person, and some of the others tapped their feet and enjoyed the music. One person held a toy lion on their lap, and stroked it with a smile on their face. A visiting relative said that the staff tried very hard with the activities, and the staff we spoke to said that they were all involved. The range of activities was imaginative and flexible. On the first floor, one area had been redecorated and furnished as a traditional pub (but without the drinks!) Another room was being refurbished as a typical 1950’s kitchen. This has now been completed, and we saw photographs of activities taking place there such as peeling vegetables, baking, and washing clothes. Everything we saw during this inspection confirmed the observations that we made in April. We spoke to visiting relatives on both occasions. They are made welcome in the home, and always offered well laid trays of tea and biscuits. What we could do better is to improve one to one activities for residents who are unable to join in group activities. The manager recognises that further improvements could be achieved, and in the Annual Quality Assurance Assessment (AQAA) said, “What we could do better is to improve one to one activities for residents who are unable to join in group activities. In the next 12 months we plan a weekend activity programme.” We observed lunch on both floors, and supper on the first floor. There is a good choice of food at each mealtime, and all the meals are prepared from fresh ingredients in the home. The Chef is passionate about providing fresh, nutritious and tasty food for the people in the home. One indication of the quality of the food was that many of the staff choose to eat it themselves. Snacks are available in the lounges for people to help themselves to, and hot and cold light snacks are available throughout the night, with a ‘Night Bites’ menu. Everyone was offered frequent drinks through the day, and those who needed help were encouraged and assisted to drink them. DS0000019344.V366250.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are confident that their concerns are listened to, and that they are safeguarded from the risks of abuse. EVIDENCE: There is a satisfactory complaints procedure in place. Five complaints have been recorded in the home in the last twelve months, all of which were resolved to the satisfaction of the people who made the complaints. A relative of one said that they know who to speak to if they are not happy. “Staff always available. However my [name] doesn’t understand who they are speaking to. But can find someone.” BUPA Care Homes has robust policies for dealing with allegations of abuse or neglect. All the staff have training in safeguarding vulnerable people, and those who we spoke to were aware of the whistle blowing policy and who to speak to if they have any concerns. The Annual Quality Assurance Assessment (AQAA) stated that BUPA Care Homes has appointed a Director of Quality and Compliance and has developed a national Quality and Compliance team of experts. In the next 12 months BUPA plans to educate staff in the importance of reporting and responding to any concerns, and to ensure that all staff are aware of their importance in relation to these areas. DS0000019344.V366250.R01.S.doc Version 5.2 Page 20 There have been two safeguarding investigations since the last inspection. Appropriate actions were taken as a result, including disciplinary actions. DS0000019344.V366250.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home and gardens provide a comfortable, attractive and safe environment for the people who live there. EVIDENCE: Elstree Lawns is a large, three-storey building, which has been converted and extended. The decorations and furnishings in the home are domestic in style, and provide a homely and comfortable environment. There are gardens and patio areas to the rear of the home and these have been modified for the safe use of the residents. When we visited the home in April the carpet in the lounge on the first floor had been changed, and this is now a plain colour, which is more suitable for people with dementia. A stair lift had been installed on the steps between the DS0000019344.V366250.R01.S.doc Version 5.2 Page 22 lounge and dining room on the first floor. The home’s action plan stated that bedroom doors are not locked unless a resident is in hospital. This means that people have unrestricted access to their rooms at all times. The furniture that we saw looked clean, and we noticed no offensive smells in the home. On this occasion the home appeared to be comfortable and welcoming, with a variety of different rooms for people to use. These include an area on the first floor that has been redecorated and furnished as a traditional pub, and a room that has been refurbished as a typical 1950’s kitchen. (See Daily Life and Activities.) Appropriate hoists are in place for people who need them. (See Health and Personal Care.) Further changes could be made to make the environment more suitable for people with dementia. This includes further differentiation of different areas, for example by the use of colour, textures or themes, so that people can identify different areas more easily. The garden is well used as a seating area, but half of it is under used, or unused. The design and best use of this could be investigated to make it a positive area for everyone in the home to use. The home appeared to be generally clean, and appropriate procedures are in place for the control of hygiene and for effective management of laundry. One lift was out of order when we visited, and needed a major repair. It was reported that BUPA now has a plan for every home to have a 5 yearly strategic refurbishment, which should ensure that all equipment and facilities are maintained effectively. DS0000019344.V366250.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are supported by a stable staff team who have the experience and training to understand and meet their needs. EVIDENCE: When we visited the home in April the staff who we spoke to said that their knowledge and practice has improved. There was a rolling programme of moving and handling training and most of the staff had completed this training. We observed some very good interactions between staff and residents, which show that they have a good understanding of the needs of people with dementia. On this occasion we were again impressed by the attitude of the staff, and the understanding that they showed of each person’s individual needs. We spoke to several members of staff individually, and to a group of nurses. One person said that they have had a lot of training and they have good information on each person’s individual needs. The nurses said that the new manager has made a lot of difference, and they all feel much happier working in the home. The enthusiasm of the staff for the work that they do was impressive. The change that they appreciate most is the daily staff meeting that includes all the staff, including domestic and kitchen staff. This DS0000019344.V366250.R01.S.doc Version 5.2 Page 24 promotes good team working, with everyone sharing responsibility for the quality of life in the home. The staff rota showed that there are at least 2 nurses and 6 carers in the home during the day, and one nurse and four carers at night. At lunchtime all the staff are on duty, and the activities staff also assist with supporting people to have their meals. However when most of the staff have their break after lunch there is a risk that there may not be sufficient staff in the home. Visitors who we spoke to expressed their concerns that staff are not always readily available at this time. The staff work 12 hour shifts. This is their choice, and they do not work excessively long weekly hours. However the long shifts means that there is less room for flexibility, to make sure that sufficient staff are on duty at all times during the day. BUPA Care Homes has achieved Investors In People (IIP) accreditation. There is a robust recruitment procedure that includes checks on identity, references and a Criminal Record Bureau (CRB) disclosure. This ensures that as far as possible the company is confident that the staff that are employed in the home are fit to work with vulnerable people and to protect hem from harm. The company provides a good range of training opportunities, and the training matrix that we saw showed that everyone has had the mandatory health and safety training, and training in dementia care, moving and handling, and safeguarding vulnerable people. 9 of the 28 permanent and bank care staff have NVQ2 or above. This is below the expectation of 50 qualified care staff. DS0000019344.V366250.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed. The views of the residents and other involved people are actively sought in order to ensure that a good quality of care is provided. EVIDENCE: The home has not had a registered manager for at least four years. One person managed the home for two years, but his application for registration was refused because CSCI considered that he was not a fit person to manage the home. The next manager who was appointed to the home did not apply for registration, and left the home in April 2008. Since June 2006 the CSCI has consistently assessed the home as providing poor outcomes for the people DS0000019344.V366250.R01.S.doc Version 5.2 Page 26 who live in the home. In April 2007 the home was assessed as adequate, but at the last key inspection in November and December 2007 it was again a poor service. Following the departure of the last manager, the home was managed by a BUPA Regional Support Manager, and the former manager of another BUPA home, who worked three days a week as deputy manager. This person has now been appointed as manager of the home, and she has started the process of registration with the Commission, which will confirm that she is a fit person to manage the service. Although the home where she was previously a manager did not provide a service for people with dementia, she was previously deputy manager at a home that did provide dementia care. She plans to update her knowledge with an accredited Quality in Dementia training course. The home is now in the process of recruiting a new deputy manager. When we visited the home in April the acting manager had started putting processes in place for better recording and management of procedures in the home. The home’s action plan indicates that all the requirements that were made at the last inspection have been addressed. Senior staff have been given individual responsibilities, for example for moving and handling and medication, for wound care, and for MUST (Malnutrition Universal Screening Tool). The new manager has audited all the care plans and medication (See Health and Personal Care). The staff who we spoke to confirmed that the management of the home has improved. One person said, “The staff were not checked before, but we are monitored now.” This supervision and support is seen as a positive thing by the staff, and they said that the managers listen to them. There is good communication from the managers, and effective handovers of information for each shift. The manager has introduced new tight procedures for ensuring that all accidents and incidents are recorded properly, and notified appropriately to CSCI and other authorities. There have been no incidents that require notification since January. A sound quality assurance system is in place that meets the needs of the service. Annual questionnaires are sent to all the residents and their families, and a satisfaction survey report is produced which includes comments from the residents. BUPA carries out an annual audit of all aspects of the service provided by the home, with a resulting an action plan. The BUPA Regional Manager makes monthly visits to the home to monitor the quality of care provided. The arrangements for management of residents’ money were inspected and appeared to be accurate. Systems for managing the residents’ finances are transparent and backed up with signatures and invoices. Money is stored safely and adequate records are maintained in order to protect service users from financial abuse. DS0000019344.V366250.R01.S.doc Version 5.2 Page 27 The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff follow the home’s policies and procedures. These include monitoring water temperatures and ensuring that there are regular fire drills. DS0000019344.V366250.R01.S.doc Version 5.2 Page 28 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 X 3 3 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 3 X 3 X X X 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 3 X 3 X 3 X 3 3 DS0000019344.V366250.R01.S.doc Version 5.2 Page 29 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 OP8 Regulation 12(1)(a) Requirement All health care needs must be recorded appropriately in order to prevent any avoidable risks to the resident’s health. In particular, proper records must be kept for monitoring people with poor nutrition. The home must have a clear policy on the covert administration of medicines. This must include guidance on the action to take if it is necessary. It must include consideration of the person’s ability to take the decisions about their medication in accordance with the Mental Capacity Act 2006 The registered person must put measures in place to increase the number of qualified staff working in the home. Timescale for action 30/09/08 2. OP9 13(2) 30/09/08 3. OP28 18(1)(a) 31/12/08 DS0000019344.V366250.R01.S.doc Version 5.2 Page 30 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 OP8 Good Practice Recommendations The care plans and risk assessments should be reviewed to make sure that the staff have the information that they need to be able to meet people’s needs appropriately. The manager should ensure that staff follow all guidelines in care plans. In particular, staff should take account of people’s preferences for bedding and other environmental preferences that may affect their wellbeing. Two members of staff should sign the controlled drugs register when a controlled drug is administered, to confirm that the correct dosage is given. 3. OP9 DS0000019344.V366250.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000019344.V366250.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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