Inspection on 02/02/06 for Ilsom House Residential & Nursing Home

This inspection was carried out on 2nd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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

Ilsom House Residential &... 28/03/07

Ilsom House Residential &... 16/06/05

Ilsom House Residential &... 22/11/04

Ilsom House Residential &... 26/07/04

Ilsom House Residential &... 03/12/03

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Ilsom House Residential & Nursing Home Tetbury Glos GL8 8 RX Lead Inspector Mrs Janice Patrick Unannounced Inspection 11:30 2 February 2006 nd 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 Ilsom House Residential & Nursing Home DS0000016483.V269820.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. Ilsom House Residential & Nursing Home DS0000016483.V269820.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ilsom House Residential & Nursing Home Address Tetbury Glos GL8 8 RX 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) 01666 504131 pitchejaupa.com BUPA Care Homes Limited Mrs Janet Elizabeth Pitcher Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38), Physical disability (38), Terminally ill (38) of places Ilsom House Residential & Nursing Home DS0000016483.V269820.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th June 2005 Brief Description of the Service: This Care Home is part of the BUPA Care Homes Group and provides care for the elderly person requiring personal, but predominantly nursing care. It sits back off the main road to Cirencester, just outside of Tetbury town. The building is an older property that has been extended with gardens that overlook the local countryside. There is also ample car parking. Accommodation is over two floors and consists predominantly of single bedrooms all with en suite facilities. There are spacious communal rooms on the ground floor and ample communal bathing and toilet facilities. The Home has a passenger lift and stair lift to aid access to the first floor. All entrances into the Home are level to the ground making wheelchair access easy. This Home is popular and well established in the local area. Ilsom House Residential & Nursing Home DS0000016483.V269820.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector between the hours of 11:30am and 2:45pm. The Registered Manager was on duty as were other members of the Home’s team. Requirements from the previous inspection report were discussed and their progress reviewed. A selection of residents were spoken with to obtain their views on the services provided. Staff were also spoken with regarding the service they provide and their training. Other areas inspected included the staffing of the Home, recruitment of staff, quality assurance, health and safety and food. The medication system was inspected and how residents’ health needs were being met was explored. Communal rooms and some bedrooms were seen but a full tour of the building was not carried out on this occasion. What the service does well: What has improved since the last inspection? The en suite facilities that were being refurbished or replaced during the last inspection in June 2005 now look attractive and are meeting the needs of the occupant. Where the Home had previously been without an administrator for a period of time, the present administrator has been in post for seven months and a vast improvement was seen in the organisation of the staff files. There is a new Deputy Manager to support the Manager and a new Registered Nurse therefore improving the numbers within the nursing team. A staff supervision system has recommenced and records are being kept. Ilsom House Residential & Nursing Home DS0000016483.V269820.R01.S.doc Version 5.0 Page 6 The majority of staff, including some longstanding and more mature staff have commenced their National Vocational Qualification (NVQ), which enables the Home to meet the National Minimum Standard (NMS) of 50 of its workforce trained to NVQ standard or equivalent. What they could do better: 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. Ilsom House Residential & Nursing Home DS0000016483.V269820.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 Ilsom House Residential & Nursing Home DS0000016483.V269820.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): 6 This service is not provided at this Care Home. EVIDENCE: N/A Ilsom House Residential & Nursing Home DS0000016483.V269820.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): 8&9 Residents’ health care needs are met well. Some minor shortfalls were identified within the medication system, which if audited soon and rectified should not put residents at risk. EVIDENCE: Due to the closure recently of the inpatient wards at the local hospital, the Primary Care Trust (PCT) is funding three beds within the Home. This enables individuals, who require nursing care within the category that the Home is registered to provide, to remain near to their homes and relatives. The Inspector spoke with all three who required varying degrees of care. Two were in need of specialist external health professional skills. Arrangements were in place for these specialised needs to be met; in one case this was the Pain Control Nurse visiting the Home twice weekly. Staff within the Home have a point of direct contact with these professionals at any time. Nurses within the Home also have existing and updated skills in order to administer the medication being used and to use some of the specialised equipment in use. Ilsom House Residential & Nursing Home DS0000016483.V269820.R01.S.doc Version 5.0 Page 10 Other residents within the Home also receive frequent medical monitoring as required and the skills of a physiotherapist are also available through referral from the GP and arrangements made with BUPA. On the day of this inspection the local GP visited the Home to review some of his patients health needs. The Home frequently liaises with the Mental Health Services. Additional health care professionals such as the Chiropodist, Optician, Dietician and Continence Nurse also provide regularly needed skills and support to the Home. The basic medication system was inspected. Some gaps in recording of administered drugs were seen. Handwritten entries on the administration record (MAR Sheet) required two signatures in places. Liquid medications required a date of opening. Storage of medications was satisfactory and the disposal of stock met new requirements set out for care homes with nursing. Other stocks were checked with the Registered Manager and found to be correct, but an amount had been entered on the wrong page. This was dealt with immediately. The nurse responsible for regularly auditing the system had been away and was due back soon after this inspection. The omissions found were small, poor practice issues, which would normally be monitored by this member of staff; however, nurses must remain accountable for their own practice. Ilsom House Residential & Nursing Home DS0000016483.V269820.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 & 15 Residents are helped and supported to lead a life that meets their expectations and one over which they have some control by being given the opportunity to make decisions based on choice. Dietary needs are well catered for and a varied and balanced selection of food is offered. EVIDENCE: The Inspector spoke with several residents regarding their views on the food and whether they opportunities to make choices. She also spoke with two residents particularly about their care and their control over this. One resident said she wanted to go home and was reassured that this was being arranged, but that a care package had to be in place before she could do this. When reminded of this fact the resident remembered that she did need support, but went on to speak favourably about the staff at the Home and the food. Another resident who has a terminal illness was able to confirm that he is able to make decisions about his care in conjunction with those looking after him. It was evident from what he was saying and from how the Manager was Ilsom House Residential & Nursing Home DS0000016483.V269820.R01.S.doc Version 5.0 Page 12 describing their care for him that a ‘holistic’ approach was being taken and that close family were also part of the decision-making. He said ‘I cannot fault the staff and care that I am getting here’. Another very poorly resident said she was well cared for. Her husband sits daily with her and requires some support from the staff. She asked for a tray of tea for him and this was organised straight away. The main communal lounge is attractive and domestic in character and has several areas of group seating. One table had a jigsaw, a book half read and a pair of glasses on it. The Manager explained that one resident enjoys coming backwards and forwards to this activity as he pleases. Another resident has been a keen artist all their life and was enjoying drawing in the quiet lounge overlooking the countryside after lunch. A small group of residents that are not so physically or mentally able were seen to be in the lounge enjoying the company of the activities co-ordinator. This was quiet company in a comfortable room, just talking and reading the paper together. They had also just enjoyed a cup of tea. The Home has a new chef who seems to be cooking in a way that the residents like, as all made good comments. Those requiring help with their feeding sit quietly in the main lounge and start a little earlier than the main group. Many enjoy their food in their bedroom. One poorly resident said he had gone off his food and confirmed that the chef had been to see him to talk about this. This resident said the staff get him what ever he fancies at that time. Monitoring of certain residents that could be at risk of not getting enough nutrition is carried out. The Manager pointed out one such case and how this was being managed was discussed with the Inspector. Ilsom House Residential & Nursing Home DS0000016483.V269820.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): 18 Robust processes are in place to help protect the residents from abuse or harm. EVIDENCE: All requirements laid down within the Care Home Regulations 2001 are met with regard to recruitment of staff. BUPA also have other robust policies and procedures designed to help protect the vulnerable resident. Staff speak of a zero tolerance of elder abuse and residents all confirm that they are treated well. One resident who requires a lot of physical care said that the staff are never rough in handling him and always speak kindly to him. Staff monitor closely a very specific situation between two residents, which has the potential of occurrences of psychologically bullying by one of them. The Homes zero tolerance of this has been explained to one resident by the Registered Manager, who is clear about other official avenues that are open to her in the process of protecting the more vulnerable resident. Staff receive training on Adult Protection within their induction training and in their NVQ training. The Manager was informed that new guidance would be available from April this year on this subject. Ilsom House Residential & Nursing Home DS0000016483.V269820.R01.S.doc Version 5.0 Page 14 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): None of the above standards were inspected on this occasion. N/A EVIDENCE: N/A Ilsom House Residential & Nursing Home DS0000016483.V269820.R01.S.doc Version 5.0 Page 15 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 & 28 After a period of instability within the qualified nursing team there is now a good match of well-qualified staff offering consistency of care within the Home. EVIDENCE: A new Deputy Manager has been recruited along with a new Registered Nurse. This will give the support required to the care team and the Manager. Both these members of staff bring considerable skills to the home, including dementia care and mental health skills in the case of the Deputy Manager. Within the care team, all but four have commenced or are about to begin their NVQ Award. This will give underpinning knowledge to an already experienced team. Those not taking the award are either on long-term sick leave or near retirement. BUPA will be exploring how the skills of those that hold the NVQ Award can be used more effectively. Staff spoken to confirmed that they had received various mandatory trainings and were clear as to what their role was. On the day of this inspection a training session had been planned, but was cancelled due to the trainer being poorly, there were therefore more staff on duty than usual. Ilsom House Residential & Nursing Home DS0000016483.V269820.R01.S.doc Version 5.0 Page 16 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): 33, 36 & 38 The systems for obtaining the views of residents and relatives are good in this Home and combined with an effective quality assurance system and another initiative means that the services provided for the residents are constantly being reviewed and improved. The care residents receive is monitored and improved upon through effective staff supervision. The residents benefit from living in a Home where there is good maintenance and safe practice. EVIDENCE: BUPA have an effective way of auditing and measuring the standard of care and services provided to the residents. The Manager confirmed that this system is being reviewed at present. The initiative ‘personal best’ is still in place and has been difficult to maintain in a period where the Manager’s Ilsom House Residential & Nursing Home DS0000016483.V269820.R01.S.doc Version 5.0 Page 17 priority has been the staffing of the Home and delivery of care. Staff spoken to however, made reference to having opportunities to discuss and review with the Manager how they are performing. A record of when individual and group supervision has been held was seen. This will be an area that the Deputy Manager will have more responsibility for when she has settled and completed her induction period. One bank night nurse had not received supervision for sometime according to the records. The maintenance logs were seen during this visit. All checks on hot water, lighting, call bells, fire system and equipment are recorded. There was evidence of regular contractual servicing of major systems and pieces of equipment, including the lift. All staff are updated in moving and handling which is an ongoing training. Ilsom House Residential & Nursing Home DS0000016483.V269820.R01.S.doc Version 5.0 Page 18 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 4 9 2 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 X 17 X 18 3 X X X X X X X X 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 X X 3 X X 3 X 3 Ilsom House Residential & Nursing Home DS0000016483.V269820.R01.S.doc Version 5.0 Page 19 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 OP9 Regulation 13(2) Requirement The Registered Manager must ensure that the recording of medication administration and the system generally, is being run safely and that ‘good practice’ is taking place. Timescale for action 01/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ilsom House Residential & Nursing Home DS0000016483.V269820.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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. Extracts may not be used or reproduced without the express permission of CSCI Ilsom House Residential & Nursing Home DS0000016483.V269820.R01.S.doc Version 5.0 Page 21 - 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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