Inspection on 09/01/06 for George Basterfield House

This inspection was carried out on 9th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

George Basterfield House 10/09/07

George Basterfield House 12/06/06

George Basterfield House 29/06/05

George Basterfield House 11/11/04

George Basterfield House 19/05/04

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

CARE HOMES FOR OLDER PEOPLE George Basterfield House Risedale Road Barrow in Furness Cumbria LA13 9BZ Lead Inspector Marian Whittam Unannounced Inspection 9th January 2006 10:30 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 George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service George Basterfield House Address Risedale Road Barrow in Furness Cumbria LA13 9BZ 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) 01229 894549 Cumbria Care Mrs Julie Bernadette Lowery Care Home 35 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (35) of places George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 35 service users to include: - up to 35 service users in the category of OP (old age not falling within any other category) - up to 16 service users in the category of DE(E) (Dementia over 65 years of age) The staffing levels in the home must meet the Residential Forum Care Staffing Formula for Older Adults. When single rooms of less than 12 sqm usable floor space become available they must not be used to accommodate wheelchair users and where existing wheelchair users are in bedrooms of less than 12 sqm they must be given the opportunity to move to a larger room when one becomes available. 29th June 2005 3. 4. Date of last inspection Brief Description of the Service: George Basterfield House is a care home registered to provide care for 35 residents, including 16 with dementia. The home is in a residential area of Barrow in Furness, close to the local park, leisure centre, shops, post office, public houses and other amenities. The home is on a bus route and is about half a mile from the town centre. The home is on two floors and has a passenger lift for residents .All the bedrooms in the home are single occupancy and 3 have en suite facilities. The home is divided into individual units, Linden and Elmview are EMI units and Ashlea and Oakdale are for physically frail residents. Each unit has its own non smoking lounge, kitchen and dining area in addition to the large communal lounge on the ground floor and the ground floor lounge used by service users who wanted to smoke. The home has secure garden areas that residents may use. George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was on 9th January 2006 over five and a half hours; the inspector looked at a number of records required by regulation, care plans, looked around the home and spoke with 9 residents, 2 visitors and 3 staff members and the manager. The pharmacist inspector also did an inspection of medication handling and systems that lasted 6 hours. A full report of that inspection is available on request from the CSCI local Penrith office. What the service does well: What has improved since the last inspection? What they could do better: The home needs to be more proactive in reporting changes in the management to the CSCI. The home is introducing a job share between managers and one of these managers has not registered with the CSCI. This process should be undertaken in good time to ensure that the best interests of interests of residents in that the other person undertaking the management of the home is fit to do so and is registered. George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 6 Medication practices need significant improvement specifically in the accuracy and legibility of record keeping, administration ,follow up on medication queries and documentation supporting decision making and consultation with doctors and pharmacists. Controlled drugs records and handling needed to be improved and the stock checked at each administration and regularly following receipt to make sure no errors have occurred. Staff must be competent in the procedures for handling medication. 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. George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 7 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 George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 An assessment, care planning system and information from other agencies is in place to provide the information staff need to meet resident’s needs when they come in. EVIDENCE: Individual care plans showed that all the residents had their personal health and social needs assessed before and following admission to the home and their individual care plans had developed from this. The home manager or senior staff do an individual assessment of needs in addition to social services care management plans to try to ensure that the home is able meet those needs before residents came to live there. Where appropriate other care agencies and professionals were involved in providing information and making assessments of the needs to be met. George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 A care planning system is in place and the personal, social and health needs of residents are being assessed and met. However care plans for “when required” medicines need to be in place so staff know what to do. The handling, recording of medicine administration and risk assessment for self medication needs improvement and medication queries properly documented and followed-up to safeguard residents. EVIDENCE: All residents have an individual care plan, based on initial assessments, setting out assessed health, social and personal care needs and these are being reviewed. Healthcare needs are being identified at assessment and residents confirmed they were consulted about their care plans “from time to time”. However care plans for “when required” medicines are not in place and not all medication queries are properly documented and followed-up. This may have an effect on meeting some resident’s health care needs in regard to specific medical conditions. A resident had a “when required” antipsychotic prescribed and the care plan failed to detail the requirements for administration of this medicine for staff to follow. This medicine had needed administration on a number of recent occasions and the records show that staff had sought clarification from the “on-call” GP service. However, this had been prescribed George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 10 prior to this for several months with no care plan is in place for staff. Another resident has “when required” propranolol and there was no care plan in place. Staff were unaware of the indication for its use. The records for medicines administration and receipt are not always clear and the handling of controlled drugs needs improvement and regular stock checks. The pharmacist inspector inspected medication records and handling and a full report of the findings are available on request from the CSCI Penrith office. George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 and 15 The home provides some social activities within the home and staff support residents to maintain their own affairs, outside contacts and interests. There is variety and choice in the food on offer and special dietary needs are catered for. EVIDENCE: Regular organised activities, musical events and religious services are provided and advertised on the notice board within the home. Care plans contain information on resident’s hobbies, interests and religious preferences. Residents said that they could come and go as they pleased and staff assisted them in maintaining their outside interests. This was evident for one resident who went out in town each day and visited friends at a local club. A supervisor and a carer have responsibility for coordinating the activities. Staff on the different units do individual and group activities as their work allows. One resident said how much she enjoyed the twice weekly bingo sessions and that staff did crosswords with them. Another resident spoke of a Christmas shopping trip and Bonfire Night activities in the home but had not been out on any trips. Activities have been discussed at residents meetings and on satisfaction surveys and comments were being acted upon. Activities outside the home are not happening very often and residents commented on this and George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 12 the home should improve this using the resident’s suggestions for outside activities. Menus had been discussed at the residents meetings and residents confirmed an improvement in the quality of food provided. More than one resident said the food was “very good” and “plenty of it”. One resident said he always had a “good cooked breakfast” that “sets me up for the day”. The home has recruited a permanent cook and some residents expressed the view that the standard of catering was now consistently better. The lunch time meal offered a choice and was well presented and residents did not make any complaint about the lunch to the inspector when asked. The menus provided showed a nutritious and varied diet that residents had been able to comment on. George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The home has a satisfactory complaints procedure available within the home and a system for logging and responding to complaints in place. There are satisfactory adult protection in place to help protect vulnerable adults and these are available for staff in the home. EVIDENCE: Since the last inspection the home has received two complaints and one to the CSCI. The home has had one adult protection investigation following and allegation of abuse. All have followed correct procedure and been addressed by the home and other relevant agencies. The home has a complaints procedure and system for logging complaints for investigation and the procedure was available to residents. Residents spoken to said that the manager or supervisor would deal with any complaints they made and they could tell staff. Advocacy services were available to residents and the home had information on this if they wanted someone to act on their behalf. Staff are given training and information on adult protection, suspicions of abuse and on dealing with aggression to promote residents safety and well being. Staff spoken with were clear on what they would do, in the first instance, if they thought someone was being abused in the home. Staff were observed dealing with sensitive situations and conflict between residents. They were calm, sensitive and used tactics to try and defuse the situation. George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 14 The home did not deal with any resident’s personal finances only small amounts of spending money for safekeeping. George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22 and 26 The home is clean, tidy, homely and adequately maintained for residents and has the equipment they need to promote mobility and independence. EVIDENCE: There is a programme of maintenance and improvement for the home. The exterior of the home has been repainted and the maintenance plan shows that new carpets and redecoration is budgeted for. The dining and lounge areas on the units are used for daily activities, and residents sat reading their papers and watching television. Resident’s bedrooms seen by the inspector had locks for privacy, satisfactory decoration and had suitable lighting and furnishings. Many rooms had residents own possessions and this made them more personal and homely. The home and the laundry facilities are clean and tidy and systems in place to minimise risks from Legionella and test water temperatures. There is a range of equipment and adaptations in the home to help residents make the most of their independence and to get about the home. George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 16 George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 28 Staffing levels were adequate with appropriately trained staff offering consistency of care to residents. EVIDENCE: After a period of staff changes and shortages the rotas suggest the home now has a more stable and consistent care staff group and are managing to maintain adequate staff levels. The home had recruited some new staff, extra hours for general assistants and some administrative help and had adequate domestic cover. Residents spoken with said that there was usually a ‘floater’ on duty to help out and praised the hard work and dedication of the staff. The number of staff with NVQ Level 2 in care has increased to meet the level required. Staff spoken with were well motivated and supported to take on training and to progress in their NVQ qualifications. George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37 and 38 The home reviews aspects of its performance through audits, quality surveys and residents and staff meetings and maintains satisfactory records required by regulation. There is an experienced manager in post and the management approach is open and inclusive. There are procedures and systems in place to safeguard resident’s monies and welfare. EVIDENCE: There are quality monitoring systems and procedures in place. Regular staff meetings allowed staff feedback, along with internal reviews of policies and procedures. Residents said that they see the manager most days and could raise issues with her or the supervisor. There are records of residents meetings taking place in the home and these meetings are advertised on the units. The home has done satisfaction surveys for residents, families and health care professionals. Issues raised by the recent survey are being acted upon. The standard of record keeping and organisation of information is satisfactory. George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 19 Policies and procedures are in place to protect resident’s financial interests and to safeguard spending money given to the homes for safekeeping. There are health and safety procedures in place to promote the interests and safety of residents and records of servicing of equipment and appliances. The home has recently begun a job share for its registered manager and the new manager sharing this post must apply for registration with the CSCI to undertake that role. The manager does have a registered manager part time but the other manager should apply for registration promptly. George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 3 3 George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement The registered manager must ensure that medicines administration records Are complete for signatures for administration for all oral and topical preparations. This to have been met by 30.07.05. That MARs are not damaged by the use of hole-punchers to remove medicine names or other important information Indicate the dose administered where this is prescribed as variable e.g. “one or two tablets” That hand-written MARs are accurate for strength of medicine and type e.g. slowrelease (SR), and should be signed and double checked. Are up to date and include all current medication. Medicines must be administered as prescribed and maximum daily doses must not be exceeded A GP letter filed with the MAR indicating that medicines had DS0000035198.V259066.R01.S.doc Timescale for action 01/03/06 2. OP9 13 (2) 01/03/06 3. OP9 13 (2) 01/03/06 Page 22 George Basterfield House Version 5.0 4. 5. OP9 OP9 13 (2) 13 (2) 6. OP9 13 (2) 7. OP9 13 (2) 8. 9. OP9 OP9 13 (2) 13 (2) 10. OP9 13 (2) 11. OP9 13 (2) been discontinued must be archived if this is no longer relevant Medicines must be secure at all times. Care plans for use of “when required” medicines must be put in place in a timely fashion and there is prompt clarification with the residents’ GPs of dosage and indications. GPs must be notified if a resident persistently refuses medicines and advice must be sought. The manager must ensure that all discussions with GP and pharmacies relating to medicines, such as those relating to out-of-stock medicines are fully documented. Risk assessments must be undertaken for residents who self-medicate. The manager must query anticoagulant medication with the GP for a resident highlighted in the inspection. Procedures must be in place to ensure follow-up of queries regarding medicines and outcomes. The home must ensure documentation of multiprofessional discussions with respect to covert administration of medicines and consent from the resident where possible. The manager must investigate discrepancies in controlled drug stock and report the findings to the inspector. • Staff must be trained in the procedures for handling and recording of controlled drugs. • Supplies must be counted in on receipt and periodic stock checks must be DS0000035198.V259066.R01.S.doc 01/03/06 01/03/06 01/03/06 01/03/06 01/03/06 01/03/06 01/03/06 01/03/06 George Basterfield House Version 5.0 Page 23 undertaken. 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 OP12 OP31 Good Practice Recommendations Resident’s suggestions and preferences for activities outside the home should be put into action. Applications for registration for the job share management post should be done promptly. George Basterfield House DS0000035198.V259066.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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