Inspection on 15/05/08 for Fair Bungalows Nursing Home

This inspection was carried out on 15th May 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fair Bungalows Nursing Home 14/10/09

Fair Bungalows Nursing Home 12/06/09

Fair Bungalows Nursing Home 11/06/09

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Fair Bungalows Nursing Home Franklyn Drive Cowick Lane St Thomas Exeter Devon EX2 9HS Lead Inspector Vivien Stephens Unannounced Inspection 15 , 16 and 30th May 2008 10:30 th th Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 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 Fair Bungalows Nursing Home DS0000071076.V361856.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 Adults 18-65. 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. Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fair Bungalows Nursing Home Address 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) Franklyn Drive Cowick Lane St Thomas Exeter Devon EX2 9HS 01392 438430 Fair.bungalows@guinness.org.uk Guinness Care and Support Ltd ****Post Vacant**** Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 7. Date of last inspection 12th October 2007 Brief Description of the Service: Fair Bungalows is registered to provide nursing care for up to seven people who have learning disabilities and may also have additional sensory or physical disabilities. The accommodation consists of two connected bungalows: ‘Fair Winds’ provides accommodation for three people and ‘Fair Crest’ provides accommodation for four people. Each bungalow has it’s own facilities although people can move from one area to the other through an interconnecting laundry room and office. At the time of this inspection fees were £1,355 per week. Additional costs of £221.70 per quarter are charged for the use of the home’s transport. Fuel for the transport is charged monthly according to use. People may also be expected to pay for some activities, and for personal items such as toiletries and clothing. A copy of the last inspection report is held in the home’s office and can be seen on request. An easy read summary report of this inspection has also been written. Fair Bungalows Nursing Home DS0000071076.V361856.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 2 star. This means the people who use this service experience good quality outcomes. Several weeks before this inspection took place we sent an annual quality assurance assessment form to the home. The completed document was returned to the Commission and this has provided us with information about the home and the way it is run. We also sent out survey forms to relatives, health and social care professionals, and staff. We had not seen the responses to the surveys at the time of this inspection – they arrived two weeks later. We received three responses from relatives, three responses from health and social care professionals, and three responses from staff. The outcome from the surveys have been incorporated into this report. This inspection took place over 1½ days, with a further visit several days later to check recruitment files. During that time we talked to Caroline Sheppard who has been appointed as the manager of the home (although she is not yet registered). We also spoke to four staff, plus the parents of one of the people who lives at the home. A representative of Guinness Trust also attended on the second day. The people who live at Fair Bungalows have communication difficulties and therefore we observed the way they interacted with the staff team. We also talked to two of them with the help of the staff team or their parents, who explained the communication methods they use. We carried out a tour of the bungalow and looked at the records the home is required to maintain. What the service does well: No new people have moved into the home for several years. However, they have good procedures in place if a vacancy should occur at any time in the future. The home has an experienced staff team who know the people living in Fair Bungalows extremely well, understand their individual communication methods, and provide assistance and care in a sensitive and supportive manner. We talked to parents and staff and found that people are offered choices and encouraged to make decisions throughout each day. People are protected from abuse by clear procedures and well trained staff who fully understand the procedures they must follow if they have any concerns. Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 6 We looked at the staffing rotas and found that there are sufficient staff on duty most days. Careful checks have been carried out on new staff to ensure they are suitable. A good range of induction and ongoing training has been provided. Staff told us they feel well supported both by regular formal supervision and through day-to-day support from the manager. People told us they felt the home is well managed. The home meets regularly with the parents who advocate on behalf of the people living in the home. This means there is good involvement with all of the people who care for or support the people who live at Fair Bungalows. The home follows good health and safety procedures. Staff have received regular training and updates on all health and safety topics. This means that people can be assured they are safe. What has improved since the last inspection? What they could do better: We found that the two care plans that had been completed by the time of this inspection. The new care plans were comprehensive. However, the remaining care plan files had not been updated or checked for accuracy and we found that some information was out-of-date and gave conflicting instructions. While we were assured by the staff we met that they knew the correct Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 7 procedures to follow, we were concerned that agency or bank staff may not have access to the correct procedures and this may potentially place people at risk. While medication practices were generally safe, some aspects could be improved to ensure complete safety at all times. The home does not have secure storage facilities for controlled medicines or for medication requiring refrigeration. We also found that prescribed creams and lotions administered by the home have not been recorded each time they have been administered and there is no system of monitoring the effectiveness of the creams or lotions. We were also concerned that the medicines are currently stored in the office – this room in also a busy thoroughfare between the two sides of the bungalow – and this may result in the person administering medicines to be interrupted, and therefore at risk of making errors. Although recent improvements have resulted in the bungalow beginning to feel more homely, some areas still need attention. We saw a plan that has been drawn up to address some of the most immediate problems and we were given assurances that a carpet in one of the lounges will be replaced along with the dining furniture in each part of the bungalow. However, no long term plans were in place to address the longer term redecoration and maintenance needs of the home. Some people who live at the home have agreed to purchase furniture and equipment but we found that people were unclear what they were expected to pay for and what the home will provide. There is still an unpleasant odour in one lounge, and it is not pleasant for people who use this room. Some aspects of the layout of the home did not make best use of the space available. The office is poorly located between the two parts of the bungalow and is used as a thoroughfare. This makes it liable to constant interruptions that may affect the smooth running of 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. Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 Quality in this outcome area is good Good admission procedures are in place that help people get to know Fair Bungalows and feel certain it is the right place for them before they decide to move in. However, failure to provide individual terms and conditions of residency has resulted in some people being unsure what they may be expected to pay for in addition to the home’s fees. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The people living at Fair Bungalows at the time of this inspection have lived there for many years and there was no indication that anyone would be moving out or new people moving in for the foreseeable future. The home’s Statement of Purpose says that ‘Admissions are always planned. There are no emergency facilities at Fair Bungalows or intermediate care admissions. Referrals to Fair Bungalows are made via Care Manager or the local Social Services Departments who will refer to the Housing and Care Managers at Guinness Care and Support. As the existing Service Users within the home are young adults with severe learning disabilities and, or physical disabilities, attempts will be made to Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 10 match Service Users within the same age group and learning disability. This will be part of the admission criteria.’ A new care planning system has been introduced at the home in recent months and this system would be used to ensure any prospective new person’s needs would be fully assessed before any decision to move in is made. At the last inspection it was recommended that each person should be given a copy of the home’s Terms and Conditions of Residency that is specific to them – this has not been done. We saw copies of this document in people’s files but the document had not been completed with their name or room number, and was not signed by them or their representative. During this inspection we talked to the parents of one of the people living in the home about what people may be expected to pay for, and what they can expect the home to supply. They were unaware of the terms and conditions of residency or what their daughter might be expected to pay for. We advised that further information should be provided to ensure that people fully understand their rights. Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is adequate. People’s needs are met by experienced, sensitive and skilled staff who are highly tuned to the individual communication methods of each person living at Fair Bungalows. People are offered choices and encouraged to make decisions throughout each day. New care plans are being introduced that provide staff with detailed instructions on all aspects each person’s needs and how these must be met. However, some care plans have not been updated yet and people may be at risk of poor care due to poorly organised information and instructions to staff. This judgement has been made using available evidence including a visit to this service EVIDENCE: The home was in the process of moving to a new style of care plans developed by the manager, Caroline Sheppard. Two new plans had been drawn up and a third was in the process of being written. Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 12 The new plans cover all aspects of both personal and health needs. Risk assessments have been drawn up and actions have been identified to minimise risks where possible. The plans are linked to a system of daily recording sheets in which staff record all aspects of the care provided, including food and drinks, personal care, medication. These daily report sheets have been designed to provide evidence that the tasks set out in the care plans have been carried out. Risks covered in the plans included tissue viability, weight loss/gain, nutrition, epilepsy, and mobility. Each new plan had been shared with the family or representative of each person and also with all medical and social care professionals involved in their care. Wherever possible a signed agreement has been obtained from these people to show that they were satisfied that the plans are correct and that they accurately explain all aspects of the person’s needs. These agreements have included the use of monitoring devices at night for people who suffer epilepsy (this was raised in the last inspection report). A great deal of time and hard work has clearly gone into drawing up the two new care plans. However, there were five care plans still in use in the old format. These old care plans have not been updated recently and old information had not been archived. We found that the old care plans have not been indexed or filed in an easy to access manner, and that it was very difficult to find relevant information. We talked to a member of staff about the use of the new and old style care plans. We were told that staff rarely use the old care plans because of the way information is set out in the files. On the other hand we were told that the new daily recording systems ensure that staff use the new care plans regularly. While we were concerned that written information in the old care plans may not always be up-to-date or easy to find, the staff told us about the great care taken to ensure that agency or bank staff receive clear verbal instructions at the start of each shift, and that most agency or bank staff used have worked regularly at the home and have a good knowledge of people’s needs. We were told that agency staff always work alongside experienced staff. We also observed a staff handover between shifts and heard how information was shared about each person’s current care needs. We talked to Caroline Sheppard about the need to ensure all care plans are upto-date and easy to use. She told us that it has taken her several months to draw up two care plans (with a third nearly finished), but she expected the remaining plans will be completed in the next four months. She said that delays in obtaining signatures from families and professionals had slowed the implementation of the new plans. We asked her to ensure that all of the old style plans are checked to ensure that vital information about care needs are Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 13 clear, easy to find and up-to-date, and old instructions archived until such time as the new plans are in place for each person. We talked to the staff about how they give people choices and enable them to make decisions about all aspects of their daily lives. Many of the staff have worked in the home for several years and have developed a very special relationship with each person living in the home, and highly sensitive skills in communication. The staff explained how people make choices throughout the day – an example was given of how each person wakes up and how staff recognise if the person wants to get up or if they want to go back to sleep. We heard how the staff are sensitive to the body language of each person and understand if the person indicates if they want a specific member of staff to help them with personal care tasks such as washing, bathing and dressing. We watched while breakfast was being prepared for two people, and we saw how people were offered choices and made definite decisions about what they wanted to eat and drink. Instructions were displayed on the kitchen notice boards on the individual nutritional needs for people and how the food should be prepared. Staff showed us work that has been carried out in conjunction with a speech and language specialist to develop and improve communication skills with one person. The staff were able to demonstrate highly tuned and sensitive understanding of eye movement and body language and as a result they have been able to offer choices, and they can now ‘listen’ and feel confident that they are accurately responding to the person’s wishes. They gave us many examples of excellent practice and successful outcomes for this person, including some inspirational artwork. Throughout our visit we saw people looking relaxed and happy. Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. People living at the home have the opportunity to enjoy regular and varied events and activities, both at the home and in the community, as well as benefiting from family support. People’s likes, dislikes and dietary needs have respected through well planned menus and clear recording systems. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In their Annual Quality Assurance Assessment the home told us that people enjoy a variety of activities ranging from hydrotherapy, day centres, horse riding, various therapies including Reiki, and going out for walks. During our visit we saw people engaged in a variety of activities. On the evening of the first day three people went out to the circus. A Reiki therapist Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 15 visited during the day to give treatment to five people. On the second day some people went out to local clubs. The home has a minibus and a member of staff is employed as a driver/carer to take them to the various clubs, activities and outings. In the office we saw a weekly plan of the regular activities for each person. Staff explained how these plans have been developed. In recent months the range of activities have been increased. They have gauged responses and if people have shown they have not enjoyed the activities their wishes have been respected. They talked about some of the regular activities people participate in, including attending various clubs, pub outings, horse riding, parachute club, and shopping trips. The staff were enthusiastic and motivated, and described some of the impromptu activities such as playing musical instruments and art work that they clearly enjoy helping people to participate in. We found that everyone had equal opportunity to go out and to join in outside activities according to their individual interests. One parent told us they felt the home still does not provide sufficient activities, and raised concerns that sometimes people are left too long without attention. We were unable to follow this comment up to find out if recent improvements to the level of activities has made a positive difference for this person. During this inspection we met the parents of one person living at the home who visit the home regularly. We also heard about the regular parents’ meetings held at the home. Since the last inspection we have received communications from family members keeping us in touch with what is happening. We heard that there is a very active parents’ group who work hard to advocate on behalf of the people living at the home. Money has recently been raised by families to create a secure fenced-off area of the garden where people can sit outside safely. During this inspection we saw people choosing their own breakfast and drinks. We saw sample menus, and also special instructions to staff on the type of foods that are suitable/unsuitable for individuals, and the way food should be prepared, including foods that should be puree’d. We were told that meal times are not rigid and that routines are arranged to suit each individual living in the home. We saw daily records of the food and drinks people have received each day. For those people who need to be monitored closely to ensure they have received sufficient fluids each day the records were very clear, showing exactly how much the person had drunk and at what time. One parent told us their son would like to go on holiday. We talked to Caroline Sheppard and she told us that no-one living in the home has been on a holiday arranged by the home for several years, and that this has been due to staffing Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 16 problems. No holidays are planned for the future. We asked about the possibility this may be considered, but we were told this is unlikely. Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good People’s dignity and privacy is respected and health needs are well met and supported by appropriate professionals. Medication practices are generally safe, but some practices and storage arrangements do not fully protect peoples’ health and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw some good evidence to show that staff routines are flexible and allow them to provide individual support to suit each person in the home. On the second day of this inspection we arrived at 9 am and found that two people had just got up and were about to have their breakfast. We talked to the staff about daily routines and how they provide assistance with personal care tasks. The staff were able to demonstrate a sensitivity and understanding of each person, and the way in which people should be helped with personal care tasks. Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 18 We looked at the care plans and talked to the staff about people’s health care needs. We found that the home has liaised closely with all relevant health and social care professionals, including epilepsy specialists, care managers, GP’s, consultants, clinical psychologists, occupational therapist, speech and language therapists, and dentists. The women living in the home have regular ‘well woman’ checks. We also heard that staff have received a range of training on health issues relevant to the people they care for, including epilepsy and autism. One GP told us that the home seeks advice from them appropriately. They commented “Very caring and professional team. Clients seem well cared for and happy.” Another health professional commented “Fair Bungalows manages to combine a ‘by the book’ approach to all aspects of client care with a warm hearted and nurturing atmosphere. Exemplary in all ways.” One parent told us that at times they have to remind staff to cut their son’s nails and hair – this aspect of personal care needs to be more clearly documented in the care plans. We found that a lot of time has been spent on drawing up comprehensive new care plans and found the two that have been completed were up-to-date. However, we were concerned that those that had not yet been updated may contain out-of-date information and may not be presented in an easy to use format. We looked at one of the ‘old style’ care plans and found a statement saying that the person had not had an epileptic fit since 2003. We saw instructions for staff to follow if the person should have a fit. However, on an adjacent previous page there were conflicting instructions on the treatment to give in the event of an epileptic fit. Neither statement was dated and therefore it was not clear which instructions were current. The home has a file that gives a brief overview of the care needs of each person that was drawn up for agency or bank staff – again, the information in this file on the treatment to be given in the event of an epileptic fit for this person was also out-of-date. The staff reassured us that each member is very clear about the current procedures to be followed for this person. They told us about the handover sessions where all staff are told about the changes in people’s health care needs. We were shown the handover sheet for the day that this person had an epileptic fit, and the new instructions given by medical staff. However, there remained a possibility that agency or bank staff may forget or be unaware of this instruction. The home has a range of equipment to meet people’s mobility and health needs including wheelchairs, hoists and specialist beds. However, one person had a nursing bed that was many years old, and some parts of the bed have Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 19 become worn and need repair. Their family were visiting at the time of this inspection and they told us they had been approached about the possibility of their daughter purchasing a new specialist nursing bed. We talked to them and to the manager about the requirement on the registered provider to supply any furniture or equipment necessary. We also advised the home to ensure that people (and/or their advocates) fully understand what they may be expected to pay for, and what the home will pay for (see also section 1 – Choice of Home). The manager told us that the bed could possibly be repaired. We recommended that discussions are held with the person’s family, and any other people involved in the funding of her care to determine who should pay for this equipment and how often it should be replaced. The home uses a monitored dosage system of medication. Some medications cannot be stored in the blister packs for safety and therefore some medicines continue to be supplied in bottles or packages while others are supplied in blister packs. We talked to the manager about the importance of finding a system of administration that is the safest for this home and suggested they may want to review the administration method. The medicines are stored in a secure cupboard. At the time of this inspection no controlled drugs were stored. The home does not have secure facilities for controlled drugs. Instead they have a lockable box that is chained inside the medicines cupboard. We explained that the current facilities for controlled drugs do not meet the current requirements for secure storage. If controlled drugs are prescribed at any time in the future the home must provide secure storage that meets with the required standard. We also found that the home does not have a lockable fridge for any medicines that must be kept cool. None were stored in the home at the time of this inspection. The manager told us they have a lockable box in the fridge in the kitchen if necessary. Each person has a laminated sheet in front of their administration of medicines record. This sheet has a large photograph of the person and special instructions to the staff about how their medicines must be administered. This is good practice as it provides an additional safety measure to ensure people receive their medicines correctly. We watched as medicines were being administered. Medicines were dispensed into a medicine pot in the office on an individual basis, taken to the person, and then the member of staff returned to the office to sign the record. An error in the administration of medicines occurred recently. We talked to the manager about the reasons why the mistake occurred. We were assured that this was a one-off mistake and that the member of staff followed good practice as soon as the error was realised. We did, however, feel concerned that during our visit the office was very busy due to phone calls and people walking through from one side of the bungalow to the other. The mistake occurred when the member of staff in charge was busy/under pressure. At the time of Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 20 this inspection the medicines were stored in the office, and this room is also use as a thoroughfare from one side of the home to the other, resulting in significant interruptions. (See also Conduct and Management of the Home). Creams and lotions administered by the home have not been recorded. The home does not keep a record of skin condition in response to the use of the creams and lotions – this is recommended. Staff have received some training on the safe administration of medicines in the past. Further training is about to be provided to all staff through a comprehensive training pack that incorporates a test at the end of the training to check the person’s understanding and competency. Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good People are protected from abuse by clear procedures and appropriately trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The people living at Fair Bungalows have limited communication skills and they would be unable to tell people if they wanted to complain about something. We talked to some of the staff about how they spot the signals that might indicate that a person was unhappy. Many of the staff have worked in the home for several years and know the people living in the home well enough to spot the signs of unhappiness or discomfort. They talked about the open atmosphere within the home where they felt comfortable to raise concerns with other staff or with senior managers. One staff member said there is no bickering or back-biting among the staff. If they see something they feel uneasy about they speak out immediately. One member of staff who completed a survey form said “I received excellent training on POVA and have opportunities to raise concerns at supervision.” We also talked to the parents of one person living in the home. They told us about the regular parents’ meetings that are held in the home and how the parents are able to speak out about any issues or concerns. They said they felt able to talk to the manager if they had any concerns about their daughter. Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 22 The staff have received a range of training on the protection of vulnerable adults. In addition the manager has devised a supervision recording form that specifically directs her to question staff about any potential concerns they may have about poor practice or potential abuse. In this way she can be certain that issues are raised and dealt promptly. We talked to the staff about their understanding of the way potential abuse issues should be dealt with. They were able to give an example of an issue that was dealt with in the past in the home. They described the way senior managers supported them through the process, the investigations, and support for staff who ‘blew the whistle’. The staff said they felt confident they could raise concerns again in the future if necessary, safe in the knowledge that the organisation would deal with the matter in a fair and thorough manner. The home has a philosophy of no restraint. Care plans showed that detailed discussions have taken place with relevant professionals to guide staff on how to deal with difficult or challenging situations. The home has safe procedures in place for handling people’s finances. Bank accounts are operated on behalf of people and monitored by the provider. This ensures people’s finances are fully protected. We looked at the accounts of three people. We found that the records were clear, regularly checked, and accurate. Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is adequate Recent improvements have resulted in the bungalow beginning to feel more homely, although some areas still need attention. The home was found to be clean and safe but odour control continues to be a problem in one area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection a number of improvements have been made to the bungalows and we saw a plan that has been drawn up to address further areas that would benefit from improvement. The kitchens, some corridors and one dining room have been, or were in the process of being, painted. The kitchens have been painted in bright colours and have been given some attractive finishing touches that have resulted in a bright, fresh and modern look. One dining room was painted by a person who Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 24 lives in the home, with assistance from a member of staff – this was an excellent example of how the people living in the home have been involved and consulted about the way the home is decorated. Three parents who completed survey forms told us they felt that the maintenance and decoration of the home and the state of the furniture and fixtures was poor and needed attention. One person also commented that the maintenance and upkeep of the gardens was poor. A member of staff also commented “ The physical environment is needing a lot of work to be done. There is a decorating programme in hand. Faults are identified and work is carried out as and when required but I think there needs to be a bigger investment in repairs and renewals. The gardens and grounds, fencing etc, also needs a lot of work done immediately.” The bungalows are surrounded by level gardens. At the time of this inspection the lawns had been mown, although the edges and planted areas appeared overgrown. We were told that the person who cuts the lawns would be returning at some stage to attend to the edges and overgrown areas. The parents have recently raised funds to fence off the path at the back of the bungalow, and to create a small secure area where people can sit outside safely. A soft surface has been laid and new garden furniture purchased. Some of the dining furniture has become old and worn and we were told that this was about to be replaced. We talked to the manager and staff team about how they will involve everyone in choosing the new furniture but they had no firm plans at that stage. Bedrooms have been individually decorated and furnished to suit the tastes and interests of each person. Since the last inspection an incident was noted where an agency member of staff raised a concern that the bath water temperature was too hot. We talked to the manager about this and she assured us that water temperature is checked every time a bath is run. Thermostatic valves have been fitted to hot taps to ensure water temperatures are safe, and the practice of checking the temperature every time a bath is run ensures that if the thermostatic valves fail it is noted immediately and repairs are ordered straight away. At the last inspection there was an unpleasant odour in one lounge. We were told that the home had purchased a carpet cleaning machine but this had not overcome the problem. At the time of this inspection there was still a strong odour in the room. The manager said they were considering replacing the carpet with laminate flooring. The home employs a member of staff for cleaning. A list of regular cleaning duties has been drawn up for this person to follow. The home also has Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 25 implemented new infection control procedures since the last inspection, drawn up by one of the nursing qualified staff. Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is good Staffing levels are sufficient to meet people’s needs. Careful checks have been carried out to ensure new staff are suitable and people are protected from harm or poor care. Staff have received a good range of training and supervision in order to give people the support they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We were given a copy of the current staff rota. This showed that there were sufficient staff on duty at the home at all times to meet the needs of the people living there. During the day there is usually at least one qualified nurse plus three care assistants. At night there is one qualified nurse and one care assistant. At the time that the annual quality assurance assessment was completed it showed that the home had used a high number of agency staff hours in the months previous. However, by the time this inspection was completed we saw recruitment documents that showed that two new staff had been recruited and that this would significantly reduce the number of agency staff used in the Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 27 future. We were also given reassurance that the manager very carefully checks the suitability of agency staff before they arrive, and, wherever possible, only agency staff who regularly work at the home are used. Evidence of the training and recruitment checks are seen by Guinness Trust. We checked the recruitment files of the two staff who have been recruited since the last inspection. We found that at least two satisfactory references, a POVA 1st (protection of vulnerable adults check) and criminal records check had been received before the new staff were confirmed in post. All new staff have received 1 day initial induction covering all essential information such as fire procedures. This is followed by a 12 week structured induction procedure covering all areas of care. We saw evidence of the areas covered and confirmation by the manager and staff member to confirm competency in each area. One member of staff told us “I was given a very thorough induction. “ All nursing qualified staff are checked on a regular basis to ensure they have kept up their professional registration. We saw the supervision notes of two staff – this showed that staff have received regular supervision and support. We also heard that regular staff meetings are held. New staff have received training on all mandatory health and safety subjects within a very short period of time after starting work. We saw a training plan showing the dates of all future training planned for each member of staff. The manager also showed us training that has been, or is planned for the near future, on topics relating to the care needs of the people living in the home. These subjects included epilepsy awareness, ‘total communication’, and skin care. We were told that the qualified nursing staff are keen to use their skills to provide training to the rest of the staff team on any topics that are relevant – these training sessions are usually incorporated into the regular staff meetings. During the inspection we talked to three members of staff about the way staff have been recruited, trained and supported. The staff were positive about all of these aspects of their employment. Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 Quality in this outcome area is good The home is well managed and operates in the best interests of the people living there. The office is poorly located and liable to constant interruptions that may affect the smooth running of the home. People are safeguarded by well-trained staff and up-to-date policies and procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 29 Caroline Sheppard has managed the home full-time since September 2007. An application for registration is likely to be submitted in the near future. She is a registered nurse and has had many years experience managing care homes. A representative of Guinness Trust visits the home at least once a month to carry out regular management checks and ensure the home is running smoothly. We received some very positive comments by staff about the way Caroline Sheppard has managed the home. These included “I have found my regular supervisions to be very supportive and motivating. I feel I can go and talk to my manager at any time about concerns I have regarding service users, staff or personal issues.” Another person said they have “Good support from the home manager who has over the last 18 months has turned the unit around, and is making progress to provide a high standard of care for the service users.” During the inspection we sat in the office while talking to the manager and staff and while checking the home’s records. We found that the office is sited in the middle of the two bungalows and is used as a communicating corridor. There were constant interruptions throughout the day while staff walked through the office from one side of the building to the other. There were also numerous phone calls. The medications are stored in this room and it is possible that staff administering medicines may be interrupted or distracted by people passing through the office or by the telephone ringing. They may also interrupt the manager or senior staff who may be carrying out important administrative tasks. (See also Personal and Healthcare Support). Parents’ meetings are held every three months at the home. The parents advocate on behalf of the people living at the home, and ensure the home is run in their best interest. We also heard how the home consults with all relevant professionals. Questionnaires have been sent out to people to check that the service is satisfactory and to find out where improvements could be made. Health and safety standards are met in the home following policies and procedures provided by Guinness Trust, and updated regularly as necessary. Infection control procedures have recently been improved in the home. We saw posters around the home advising staff on procedures to be followed to prevent the spread of infection. We checked the fire log book – this showed that all regular checks and maintenance of the equipment have been carried out, and staff have received regular drills and training. Staff have received training on all relevant health and safety topics. Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 3 2 3 x x 3 x Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA19 Regulation 13 (4) (c) Requirement You must make sure that an unnecessary risks to people’s health or welfare are as far as possible eliminated by ensuring that all care plans and records are up-to-date. This relates specifically to records about the action staff must follow if a person suffers from an epileptic seizure. You must review the arrangements for storing controlled drugs (including Temazepam) and medicines requiring refrigeration, to ensure that, if such medicines are received into the home any time in the future secure storage facilities comply with current legislation. Prescribed creams and lotions administered by the home must be recorded each time they are administered. Timescale for action 01/10/08 2 YA20 13 (2) 01/10/08 Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 32 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. Refer to Standard YA5 Good Practice Recommendations In order to protect people’s rights, contracts of terms and conditions should be specific, containing the name of the individual and the room they are to occupy. People should be told what they may be expected to pay for, including furniture and equipment, and what the home will provide. People should have the opportunity to go away on holiday at least once a year. Care plans should set out guidance to care staff on how and when to provide personal care tasks such as cutting nails, preferred hair styles, and how often hair should be cut. You should ensure that people have the equipment they need to help them remain comfortable, independent and safe. This includes the provision of specialist nursing beds. Equipment should be maintained in good order and suitable to meet the needs of the individual. You should have systems in place to monitor the effectiveness of creams and lotions administered to people. Clear instructions should be given to staff about the actions they should take if the skin condition worsens or improves. You should look at ways of ensuring that when staff administer medicines they are free (as far as possible) from distractions. You should consider an alternative place to store medications where staff will be less likely to be disturbed or distracted. You should continue to improve the physical environment of the home and gardens, and to ensure there is a regular programme of maintenance, decoration and renewal of furniture and equipment. In order to ensure that the home remains a pleasant place for people to live, you should ensure the premises are kept clean, and free from offensive odours, particularly longerterm deep cleaning issues. You should look at the location and use of the office and consider ways of reducing the number of interruptions due to people walking from one side of the bungalow to the other through the office. 2 3 YA14 YA18 4 YA18 5 YA20 6 YA20 7 YA24 8 YA30 9 YA38 Fair Bungalows Nursing Home DS0000071076.V361856.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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