Inspection on 17/09/08 for Ladybank

This inspection was carried out on 17th September 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ladybank 26/09/06

Ladybank 16/01/06

Ladybank 20/09/05

Ladybank 25/01/05

Ladybank 03/08/04

Ladybank 18/11/03

Ladybank 04/09/03

Ladybank 24/03/03

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ladybank 10a Ladybank Birch Hill Bracknell Berkshire RG12 7HA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Denise Debieux     Date: 1 8 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 40 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 40 Information about the care home Name of care home: Address: Ladybank 10a Ladybank Birch Hill Bracknell Berkshire RG12 7HA 01344459791 Telephone number: Fax number: Email address: Provider web address: ruth.halliday@bracknell-forest.gov.uk Name of registered provider(s): Name of registered manager (if applicable): Bracknell Forest Borough Council The registered provider is responsible for running the service Name of registered manager (if applicable) Mrs Ruth Patricia Helen Halliday Type of registration: Number of places registered: care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 42. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age- not falling within any other category (OP) Physical disability (PD). Date of last inspection Brief description of the care home Ladybank is registered to provide care with nursing for up to forty two older people or younger adults with a physical disability. Ladybank is divided into two units: Ladybank Care Homes for Older People Page 4 of 40 0 42 Over 65 42 0 Brief description of the care home Unit, which has twenty three beds: The purpose of the Ladybank unit is to provide long term care for older people who are no longer able to live independently in the community. Bridgewell unit, which has nineteen beds: The purpose of the Bridgewell unit is to provide intermediate care services to: facilitate timely discharge from the acute hospital setting; promote independence; enable people to return to their own home and/or to prevent inappropriate hospital admissions and re admissions. The home is situated close to South Hill Park, local shops and amenities are within a short walking distance. The home is owned and managed by Bracknell Forest Borough Council. Care Homes for Older People Page 5 of 40 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a key inspection and was carried out by Denise Debieux, Regulation Inspector. The Registered Manager was present as the representative for the establishment. The inspection took place over two days and was a thorough look at how well the service is doing. It took into account detailed information provided by the registered manager and any information that CSCI has received about the service since the last key inspection on 26th September 2006. A tour of the premises took place. On the day of this visit the inspector spoke with twenty eight of the forty two service users, two visiting relatives and ten on duty staff. Care Homes for Older People Page 6 of 40 On the first day of the inspection, survey forms were handed out to twenty service users and ten staff, (divided equally between the two units). All were completed and returned to the inspector before the end of the inspection. These survey forms were correlated and comments made on the survey forms, both positive and negative, were included in the correlation. Care was taken to exclude any comments that could identify the writer and the results were shared with the registered manager. The registered manager demonstrated a very pro active attitude to the results of our survey and plans to explore any concerns raised further as part of the homes quality assurance process. Some of the comments made to the inspector and made on the survey forms are quoted in this report. The home had completed an annual quality assurance assessment (AQAA) and service users care plans, staff recruitment and training records, menus, health and safety check lists, policies, procedures, medication records and storage were all sampled on the days of this visit. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Fees at the home are 562.28 pounds per week. This information was provided on 17th September 2008. The inspector would like to thank the service users, their relatives and staff for their time, assistance and hospitality during this visit and the service users and staff who participated in the surveys. ADDITIONAL INFORMATION Ladybank has two very distinct and different units, which they call Ladybank Residential Home and Bridgewell Intermediate Care Centre. These two units are at present managed and staffed very differently. The Ladybank unit is managed by the registered manager, with the assistance of an assistant manager. The Bridgewell Centre has a manager, employed by Bracknell Forest Borough Council (BFBC), who is supervised by the registered manager and reports to her. All the staff on the Ladybank residential unit are employed by the provider, BFBC. On the Bridgewell Centre, all the therapists (physiotherapists, occupational therapists, speech and language therapists, dietician), registered nurses and some of the support workers are employed by and provided by the local Primary Care Trust (PCT). The Bridgewell Centre is jointly funded by BFBC and the PCT. Over time this has led to the two units developing almost independently of the other. For example they both have separate telephone numbers which are not connected, the paperwork on The Bridgewell Centre has the NHS, PCT logo with no mention that the unit is part of the registered home Ladybank. Care workers are called care assistants on the Ladybank residential side and support workers in The Bridgewell Centre. The home also returned two AQAAs, one for each unit, which although very detailed and well filled out, highlighted the confusion within the home. This was discussed with the registered manager and provider and plans are now underway to rectify this situation. For clarity and for the purpose of this report, throughout this report: Wherever reference is made to the care home as a whole, the registered name Ladybank will be used. Wherever reference is made to the unit providing care for older people, the term Ladybank unit will be used. Wherever reference is made to the unit providing intermediate care to people with a physical disability, the term Bridgewell unit will be used. Wherever reference is made to care assistants/support workers, the term care workers will be used. Wherever reference is made to the manager, this means the registered manager for the home. Care Homes for Older People Page 8 of 40 What the care home does well: What has improved since the last inspection? What they could do better: The provider must review the organisation and management of the home. The organisational structure and accountabilities within the home must reflect that both Ladybank unit and Bridgewell unit are part of the care home registered as Ladybank and are one registered service with one registered manager. Clear lines of accountability must be established, recognising that the registered manager has overall responsibility for both units. The statement of purpose and service users guide need to be amended so that prospective service users and people working at the home are clear on the set up and management of the home. Terms and conditions need to be developed and provided to each service user admitted to Ladybank, irrespective of whether fees are payable or not. All management and administrative systems and documentation for both units need to be reviewed and unified to reflect that Ladybank is one registered service with the Care Homes for Older People Page 9 of 40 registered provider being Bracknell Forest Borough Council (BFBC) and the registered manager being Ms Halliday. It is vital that all staff are aware of and working to the same systems, policies and procedures, whether the staff are employed directly by the home or are employed by someone other than the registered provider, e.g. by the Primary Care Trust (PCT) or by an external agency. There needs to be an effective quality assurance and monitoring system established for the home that is overseen by the registered manager, that covers both units and that incorporates monitoring the quality of the service provided and the monitoring and supervision of all staff working at the home. It is recommended that the provider reviews the telephone system at the home to enable calls to be directed to the registered manager whichever telephone number is dialled by the caller. On the day following this inspection, the provider drew up and provided a preliminary, detailed action plan clearly demonstrating their understanding and commitment to improving and rectifying the issues identified during the inspection. Excerpts from the action plan are quoted in this report. The provider will be asked to provide an improvement plan setting out the methods by which, and the timetable to which, the registered person intends to improve the services provided in the care home. A copy of this plan should be made available to the people living at the home and/or their representatives. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 40 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 40 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all prospective service users are provided with the information they need to make an informed choice about moving to the home. Not all service users have an accurate assessment of their needs that they, or people close to them, have been involved in. This means that not all service users can be confident that the home can meet their needs. Dedicated accommodation is provided on the Bridgewell unit for service users admitted for intermediate care. Evidence: The home has a statement of purpose and service user guide which, up until this inspection, had been primarily provided to service users who were thinking of moving into the Ladybank unit. The manager has been reviewing the statement of purpose Care Homes for Older People Page 12 of 40 Evidence: recently and is in the process of amending the statement of purpose to be in a more suitable format and more easily understood by prospective service users. At the last inspection a requirement was made that all service users be provided with a contract/statement of terms and conditions. At this inspection it was seen that all service users on the Ladybank unit have a terms and conditions document that they have signed and agreed. The inspector was advised that contracts have not been provided to service users admitted to the Bridgewell unit as there is no charge to service users due to the health care element of the service. However, in order for them to make an informed choice, service users need clear information, other than fees, on the terms and conditions that will apply should they decide to move into the home. Of the twenty service users surveyed, eight said that they had received a contract and twelve said they had not. When asked if they felt they had received enough information about the home before they moved in so they could decide if it was the right place for them, eleven answered yes and nine answered no. The previous requirement regarding contracts has been removed. The home need to review and amend their statement of purpose and service users guide so that present and prospective service users have a clear picture of the set up of the home and the services it provides and a requirement has been made. A recommendation has been made that all service users, irrespective of who funds their care, are provided with a statement of terms and conditions at the point of moving into the home. In the AQAA, to demonstrate what the home does well, the manager stated that: (Ladybank unit) All people admitted for long term or respite care to the residential home have an assessment by the Care Manager. This is forwarded to the manager of the home, who then carries out a one to one assessment with the person to be admitted. This ensures the home provides for the needs of the individual, by using a detailed care plan of day to day needs, from their point of view, that is available to all care staff in time for their admission. (Bridgewell unit) Prior to admission we receive a referral for any prospective service user which is carefully considered to ensure that we are able to meet their needs in terms of staff skills, staffing levels, specialist equipment. On admission all service users participate in completing a comprehensive needs assessment that is used to develop their care plan including daily and long term objectives for their stay and discharge. Five care plans were sampled during this visit. The two care plans from the Ladybank unit were both seen to contain detailed pre admission assessments, including risk assessments and details of the persons preferences and choices. The care plans seen for three of the people in the Bridgewell unit all had external referral forms in place but Care Homes for Older People Page 13 of 40 Evidence: the comprehensive needs assessment as quoted in their AQAA above, had not been completed for one service user despite the person having been admitted to the home five days earlier. Additional concerns regarding care planning and documentation came to light early in the inspection which related to the safety of service users on the Bridgewell unit. This lead to the inspector making a safeguarding referral under the Berkshire Safeguarding Adults Policy and Procedures on day one of the inspection. This is discussed in more detail in the next section of this report. In an action plan provided to CSCI the day following this inspection the provider stated that: The statement of purpose to be revised to ensure that it adequately reflects the entire service provided by Bracknell Forest Borough Council at Ladybank. Work plan to commence 29th September 08. Staff to review all case files for people at Ladybank, to ensure an up to date care plan is in place which adequately reflects social care and health needs. Work commenced Thursday 17th September 08 to be completed by Monday 21st September 08. Service users spoken with on the days of this inspection were all very happy to be at the home and all were complimentary about the staff that worked with them. Care Homes for Older People Page 14 of 40 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all service users have a plan of care. This is placing the health and welfare of service users at risk. Personal care and healthcare support and assistance was seen to be provided, where needed, in a respectful and sensitive manner. Policies, procedures and practices are in place to ensure the safe administration of medication. Evidence: The two care plans sampled during this visit for service users on the Ladybank unit were both based on pre admission assessments, had been drawn up shortly after each service users admission to the home and included appropriate risk assessments. These care plans were very detailed and set out the actions which need to be taken by care staff to meet the health and personal care needs of the service users. Care plans are reviewed on a monthly basis and daily notes are kept that reflect the care given. Care plans seen had been signed by the service users to show that they had been involved in drawing up the plans and that they agreed with the content. Care Homes for Older People Page 15 of 40 Evidence: Three care plans were sampled for service users living on the Bridgewell unit. One file was sampled in depth and a number of serious concerns were identified. The service user had not had a full needs assessment and did not have a plan of care; a number of risk assessments had been carried out but, where a risk was identified, there was either no risk reduction care plan or the care plan actions were inappropriate. For example: one assessment seen identified that the service user was at risk of developing a pressure sore yet no care plan had been drawn up. A risk reduction plan was seen for the service users increased risk of falls however, one of the actions set out was that the service users call bell should be beyond reach at all times. The manager assured the inspector that this would have been an error, should say the call bell should be within reach and that the service user would always be given the call bell. While it is recognised that this was probably an error on the part of the staff member writing the plan, it is concerning that this had not been picked up in the five days that the service user had been at the home. This also means that either staff were reading and following the risk reduction instructions, placing the service user at risk; reading and not following the instructions which is against the policies of the home or not reading the instructions at all, which is also against the policies of the home. A number of forms and entries in this file had not been signed or dated by the staff member making the entries. A further two files from the Bridgewell unit were sampled, with similar findings to those in the first file. In their AQAA (dated May 08), to demonstrate what the home could do better, the manager stated that (for the Bridgewell unit): Care plans are completed as soon as possible after admission, but these are not always completed within the 5 day limit as set by the minimum standards. (It should be noted that the five day limit described in the national minimum standards only refers to people admitted in an emergency.) The inspector was also told that issues relating to certain staff on the Bridgewell unit not completing care plans had been identified in April of this year. The above findings evidenced that service users at the home were at risk of harm or abuse, no further care plans were sampled and a safeguarding referral was made by the inspector, in line with the Berkshire Safeguarding Adults Policy and Procedures. Inconsistencies in the standards of care planning between the two units were identified at the last inspection two years ago and a requirement was made which has not been met. A CSCI management review meeting will be arranged to discuss and agree the way forward, this could include the possibility of enforcement action. It is positive to note that, shortly after the provider was advised of the safeguarding referral, swift action was taken and arrangements made for the care plans of all Care Homes for Older People Page 16 of 40 Evidence: service users on the Bridgewell unit to be reviewed and any missing plans to be put in place. For the remainder of the day and a half of this inspection, additional staff were at the home helping to make sure that all service users had up to date and appropriate care plans. The providers comments from their action plan provided the day after this inspection, relating to care plans, have been quoted in the previous section of this report. Concerns regarding the absence of a management monitoring system to quickly identify and deal with these issues are addressed in the Management and Administration section of this report. The lunchtime medication round was observed and the medication administration records, medication storage, policies and procedures were all sampled and found to be in order. Since the last inspection the category of registration for the home has been amended to Care Home with Nursing. The manager was given information regarding the different legislation that governs the disposal of medication from care homes with nursing. All service users spoken with stated that they felt their privacy was always respected. Of the twenty service users surveyed, thirteen stated that they always receive the care and support they needed and seven answered usually. Nineteen felt that they always received the medical support they need and one answered sometimes. One visiting relative told the inspector how pleased she was with the care and support provided to her relative and also said that they had looked at a number of homes and felt that they had made the correct choice. During the tour of the home staff were observed to always knock before entering the service users bedrooms and all interactions observed between staff and service users were seen to be caring and respectful. Care Homes for Older People Page 17 of 40 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities provided by the home include contact with the local community both within and outside the home. Contacts with family and friends are encouraged. Meals are well balanced and varied with individual choices and preferences catered for. Evidence: The routines of daily living are arranged to suit individual service users preferences and choices. This was confirmed by service users spoken with. On the Bridgewell unit these routines form part of the service users intermediate care. On Ladybank unit, service users are able to choose which activities they attend or participate in and their individual rooms were all seen to contain personal possessions which were arranged to suit their individual wishes. Service users on Bridgewell unit are expected to attend arranged therapy sessions and are also able to chose to join in with group social activities that have been arranged for the home as a whole. Eight of the twenty service users surveyed stated that there were always activities they could participate in, two answered usually, five answered sometimes, three answered never and two left this question blank. Care Homes for Older People Page 18 of 40 Evidence: In the AQAA, to demonstrate how they have improved in the last twelve months, the manager stated that: We have recently purchased some activities for both group, or individual, entertainment, to increase opportunity to stimulate service users both physically and mentally. We have started to encourage some residents to get involved in gardening projects, and a member of staff has cleared an area in a raised flower bed to expand on service users input this year. Also in their AQAA the manager stated that they aim to increase activities of all service users to ensure that they have the opportunity to do physical movement that is additional to their personal care needs. The inspector gave details of the National Association for Providers of Activities for older people (NAPA). This is a voluntary organisation dedicated to increasing the profile and understanding of the activity needs for older people, and equipping staff with the skills to enable older people to enjoy a range of activity whilst living in care settings.Further information can be found on the NAPA website at: http:/www.napaactivities.co.uk/m This organisation also provide a free self assessment document Activity Provision : Benchmarking good practice in care homes that is available for download from that site and that the manager may find helpful. The home have also identified that they will be starting to include individualised care plans for social care for each service user, which is also identified in the action plan received the day following this inspection. Following suggestions made by service users, internet access points have now been fitted in the shared lounge and the home plans to supply a computer that can be used by all. There are no restrictions to visiting times and staff support and encourage service users to maintain family links and friendships inside and outside the home. Menus sampled showed that the home offers a varied and well balanced menu, with service users able to choose alternatives if they do not want the dish that is on the menu on the day. The lunchtime meal was taking place during this visit, the food was well presented, the atmosphere in the dining rooms in each unit was pleasant and relaxed and there were ample staff available to offer help and assistance as needed. Of the twenty service users surveyed, ten said that they always liked the meals at the home, six answered usually and five answered sometimes. One person commented that It would be better if the food could be served much hotter and three people made additional comments that the meals were very good. Care Homes for Older People Page 19 of 40 Evidence: From the evidence seen by the inspector and comments received, the inspector considers that this service is able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Care Homes for Older People Page 20 of 40 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a simple, clear and accessible complaints procedure which includes timescales for the process. Robust policies and procedures are in place to protect service users from potential harm or abuse but the home need to monitor staff understanding of, and compliance with, these procedures so that service users can be confident that they will be protected from the risk of harm or abuse. Evidence: The home has a complaints procedure in place that is available to all service users and their relatives and is also included in the service users guide. No complainant has contacted the Commission with information regarding a complaint or allegation made to the service since the last inspection. At present there are two complaint logs, one in each unit. In order for the manager to effectively monitor any complaints or concerns it was discussed that there should be one complaint log for the whole service. Of the twenty service users surveyed, eighteen said they knew how to make a complaint and two answered No. There is a whistle blowing policy in place and the home have a copy of the latest Berkshire Safeguarding Adults Policy and Procedures. Training in safeguarding adults is mandatory for all staff and all staff surveyed stated Care Homes for Older People Page 21 of 40 Evidence: that they knew what to do if a service user/relative or friend had concerns about the home. In the AQAA, to demonstrate what the home does well, the manager stated that: On day one for agency, relief or permanent staff, and work experience students, before they even go on to the units where service users are present, they complete a set induction that includes confidentiality, reporting incidents and accidents, suspected abuse, protocols for working with both residents and staff, and these are signed as understood by both the duty officer giving the information and the new staff member. Of the twenty service users surveyed, fourteen said that they always knew who to talk to if they were not happy, three answered usually, one answered sometimes, one answered never and one did not answer this question. It is of concern that issues raised earlier in this report, regarding care planning, were not identified by staff and reported to management, initially under the homes whistle blowing procedures. Safeguarding concerns should have been identified and referred by the home under the local safeguarding adults procedures. Systems need to be developed and put in place for the manager to assess staff understanding of the policies and training they have received in whistle blowing and safeguarding adults and to monitor staff compliance. A requirement has been made. In the action plan provided to CSCI on the day following this inspection, the provider identified a number of actions to ensure the embedding of a rigorous safeguarding culture these actions included: BFBC Safeguarding Adults Coordinator to provide a rolling programme of training and awareness for all staff and to devise a test which can confirm staff understanding. At all staff meetings safeguarding will be a mandatory agenda item and learning from concerns shared with those present and reflected in minutes. Ensure all staff are aware of the policies and procedures for reporting inappropriate behaviour or actions and that a culture is fostered where this is perceived as part of positive service improvement and staff development. Work to commence 21st September 2008. Care Homes for Older People Page 22 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The location and layout of the home and gardens are suitable for their stated purpose. An ongoing maintenance and redecoration programme provides the service users with clean, pleasant and homely surroundings in which to live. Evidence: Service users spoken with expressed their satisfaction with the accommodation provided at the home. Of the twenty service users surveyed fourteen said that the home was always fresh and clean and six answered usually. The home was toured during this visit. The furniture and furnishings were seen to be of a good quality and personal bedrooms were seen to be personalised to the individual service users wishes. The maintenance and redecoration programme for the home was seen to be ongoing with a number of rooms recently redecorated, including the shared lounge. A number of adaptations have also been made recently on the Ladybank unit to improve wheelchair access to the new hairdressing room and kitchen on the first floor and additional adaptations have been made to enable and encourage service users to remain as independent as possible. Laundry facilities are sited on the ground floor with washing machines suitable for the needs of the service users at the home. A dedicated laundry assistant is employed five Care Homes for Older People Page 23 of 40 Evidence: mornings a week. On the day of this visit the home was found to be warm and bright with a homely atmosphere and a high standard of housekeeping apparent. Care Homes for Older People Page 24 of 40 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current staff recruitment practices are placing service users at risk of harm and abuse. The home has a comprehensive staff training programme which incorporates all areas needed to ensure, as far as reasonably possible, that service users are in safe hands at all times, but a monitoring system needs to be in place to check that staff have understood and comply with the training received. Evidence: The staff rota evidenced that staff are provided in sufficient numbers to meet the needs of the service users at the home. On the Ladybank unit, there are three care workers and one duty officer during waking hours (8am to 10pm) with two waking care workers at night. On the Bridgewell unit there are four care workers during the morning, three during the afternoon and two waking night staff. A registered nurse is on duty on the Bridgewell unit seven days a week from 7.30am to 10pm. The nurse assistant manager position on the Bridgewell unit is currently vacant, the inspector was advised that when this vacancy is filled the nurse cover for the unit will be reviewed. A sleeping in night duty officer is available on the premises, on call each night. In their AQAA to demonstrate what they do well the manager stated that: Within Bridgewell we have a multi disciplinary team consisting of Physiotherapists, Care Homes for Older People Page 25 of 40 Evidence: Occupational Therapists, Nurses, Care Workers and have regular input from Social Workers, Dietician and Speech and Language Therapists. The Bridgewell centre runs with a set number of staff on each shift however this can be and has been increased according to the needs of our service users. Of the twenty service users surveyed, fourteen stated that staff are always available when needed and seven answered usually (one person ticked both boxes). One service user commented that: Im happy to be here, staff are great. Of the nineteen care workers, sixteen hold a National Vocational Qualification (NVQ) level 2, or above, in care. This number does not include people employed by someone other than the registered provider, e.g. staff employed by the PCT or agency staff. During this visit the files of two recently recruited members of staff were sampled. One file was seen to contain proof of identity, two references and a completed application form. A full employment history had been obtained and there were no gaps in employment. There was an email seen from the BFBC human resources department saying we have received CRB clearance but there was no evidence to show that this was an enhanced Criminal Record Bureau (CRB) check or to verify that a check had been made of the Protection of Vulnerable Adult (POVA) list. The second file sampled did not have a recent photograph, there were gaps in employment that were unexplained, one of fourteen years, one of fourteen months and one of fifteen months. Reasons for leaving previous employment working with vulnerable adults had not been verified and neither references on file were from the last employment working in care. One reference was from a previous employer but the employer was not included in the applicants employment history. The same email was seen regarding CRB clearance, again not identifying that the CRB check was enhanced or that the POVA list had been checked. In 2004 the recruitment requirements of The Care Homes Regulations 2001 were amended and Schedule 2 of those regulations was replaced with a new schedule setting out exactly what recruitment checks and documents are required. The manager was not aware of the change in legislation and the providers current recruitment procedures do not meet the requirements of the amended Care Homes Regulations and are potentially placing the people living at the home at risk. The manager was advised that updated copies of the regulations are available on the CSCI website and she has now obtained a copy. For staff working at the home who are employed by someone other than the registered person/provider (e.g. agency staff). The requirement is that the registered provider obtains written confirmation that all Schedule 2 checks and documents have been Care Homes for Older People Page 26 of 40 Evidence: obtained and that they are satisfied as to the authenticity of the references. The agency file was sampled. This contained documentation from four agencies that supply staff to the home. Only one agency confirmed that Schedule 2 information was in place but did not have a photograph of the worker. One agency sheet had a photograph of the worker but no confirmation regarding Schedule 2 information. The remaining two agency sheets did not include a photograph or confirmation regarding Schedule 2 information. Staff files for the PCT staff were held on the Bridgewell unit but were not sampled on this occasion. The amended Schedule 2 of The Care Homes Regulations 2001 was reviewed with the manager. Requirements have been made for immediate action. It is positive to note that the provider has taken immediate action to ensure the safety of service users. In the action plan provided to CSCI on the day following this inspection, immediate actions included: To review the files of all staff currently working at Ladybank to ensure regulation compliance. To obtain written evidence from agencies providing staff that they have undertaken all the checks under schedule 2 of the Care Home Regulation 2001 (as amended). Contact all relevant HR departments to confirm the need to comply and the necessity of them providing written confirmation for all existing staff immediately and routinely for all new staff recruited prior to their starting work at Ladybank. (PCT staff) work to commence Friday 19th September 08. Actions were also identified for longer term solutions such as introducing mandatory training for all staff involved in recruitment and including checking compliance with regulations in their recruitment processes. Staff induction is in line with the new, mandatory Skills for Care common induction standards and the inspector was advised that staff are supervised until they have completed their induction. The induction logbook for one member of staff was sampled and it was seen that the twelve week induction had not been completed and signed off even though the staff member had worked at the home for considerably longer than twelve weeks. The manager explained that the staff member had received all the required training but that she wanted to make sure that the staff member had fully understood and was competent before signing off the remaining topics. Staff are booked on additional training and updates as the courses become available. When sampling health and safety checklists it was noted that fridge temperatures on the units were being carefully recorded, however, a number of the temperatures were recorded as too high and there was no record that any action had been taken. The need for there to be systems in place for monitoring staff competence in, Care Homes for Older People Page 27 of 40 Evidence: understanding of and adherence to company policies on health and safety procedures is addressed in the Management and Administration section of this report. Of the twenty service users surveyed, fourteen said that the staff were always available when they needed them and seven answered usually. Service users spoken with were all complimentary about the staff, comments made included: The staff look after me well, the staff are always happy and cheerful and you couldnt wish for a better bunch! One visiting relative told the inspector how she is always made to feel very welcome at the home. When asked if they felt they were given training which is relevant to their role, helps them to understand the individual needs of the service users and keeps them up to date with new ways of working, all members of staff answered yes. When asked if there were enough staff to meet the individual needs of the people supported, six members of staff answered usually, three answered sometimes and one left the answer blank. One member of staff added that there were good working opportunities at the home and another commented I am happy with my job and like the residents, staff and management. Care Homes for Older People Page 28 of 40 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from the management approach at the home providing an open, positive and inclusive atmosphere but a review of the overall management of the home is needed so that people can be clear as to who is running the home and can be confident that standards are consistent whichever unit they move to. Policies and procedures are in place to protect service users financial interests. Policies and procedures are in place to ensure, so far as is reasonably practicable, the health safety and welfare of service users and staff, but practices need to be monitored to ensure that action is taken when risks are identified. Evidence: The registered manager is a qualified social worker and holds her Registered Managers Award qualification. The home has a quality assurance and monitoring system in place for Ladybank unit that is based on seeking the views of the service users and their relatives. In the Care Homes for Older People Page 29 of 40 Evidence: AQAA, to demonstrate what the home does well, the manager stated that, on the Ladybank unit: Residents meetings, reviews, complaints, and day to day talks with service users are all indicators of how the residents view the service. We also have a quality assurance questionnaire placed at the front door for visitors and residents to respond to the service provider. Staff training and supervisions are based around ensuring the service users views are listened to, and acted upon, and/or feedback given. Discussing care plans with individuals, and asking them to sign, indicates their approval of how we deliver their care. Care managers also give feedback on how the service meets peoples needs, or how it could be improved. However, at present these strategies are not routinely used on the Bridgewell unit and, in their AQAA, the manager stated that they plan to develop a quality assurance system for the Bridgewell unit. All staff have received required safe working practice training and updates and were observed to be following appropriate health and safety practices as they went about their work. Health and safety monitoring check sheets were sampled and found to be well maintained and up to date. However, as mentioned in the last section of this report, when sampling health and safety checklists it was noted that fridge temperatures on the units were being carefully recorded, but where the temperatures were too high there was no record that any action had been taken. During the tour of the home the inspector was advised that one service user was in hospital and they were hoping for her return that day. The commission had not received notification as required of regulation 37 and have not received any notifications since March 08. A requirement has been made. In the action plan provided to CSCI on the day following this inspection, the provider stated that: In house training sessions to be provided to foster a culture of ensuring that action is taken by involved staff when a health and safety check has identified an issue of concern, to commence 18 September 2008. As stated in the summary of this report, the two units of Ladybank unit and Bridgewell unit have developed almost independently of each other over time. This now means that there are two different systems for many management functions that could be the same, with some systems, such as a robust quality assurance system, being in place on one unit but not on the other. At times during this inspection and as described in this report, there are very different standards being seen for the same outcome group in the two units. The provider must review the organisation and management of the home. The organisational structure and accountabilities within the home must reflect that both Care Homes for Older People Page 30 of 40 Evidence: Ladybank unit and Bridgewell unit are part of the care home registered as Ladybank and are one registered service with one registered manager. Clear lines of accountability must be established, recognising that the registered manager has overall responsibility for both units. Whilst it is recognised that the two units offer very different services, these differences could be incorporated within one system rather than having two different systems. For example: The quality assurance systems currently used on the Ladybank unit, as described by the manager in the AQAA and quoted above, could be expanded to include all service users at Ladybank, perhaps just requiring some modification of the quality assurance questionnaires. By unifying the different systems, policies, procedures and practices used on the two units, it will be easier for the manager to oversee and monitor the service provided by both units and to ensure that the home is run in the best interests of all service users. The main systems discussed and identified during this inspection as needing to be reviewed and clarified included: Documentation used on both units; admission and care planning procedures and paperwork; overall monitoring of compliments, concerns and complaints; overall monitoring of staff training, including their competence, understanding and compliance with training; staff recruitment and employment; staff supervision and monitoring of practice; health and safety monitoring; overall monitoring of staff compliance with the homes policies and procedures; notification to CSCI of any incident identified in regulation 37. The action plan provided to the inspector on the day following this inspection identifies and addresses the majority of the concerns raised above. The action plan clearly demonstrates the providers understanding and commitment to improving and rectifying the issues identified during this inspection. A total of ten staff survey forms were returned to the inspector on the day of this visit. From observations made on the day and from comments made to the inspector, it was clear that the home have a close and happy staff team. Staff comments included: The manager is very good and gets things done, this is the best place I have worked, I am very happy here and so are the residents. When asked on the survey forms what they felt the home does well staff comments included: Promote independence while maintaining dignity, privacy, respect and preferences of residents, promoting independence, privacy and providing support and helping the service user to achieve their highest level or potential independence. All interactions observed between the manager, staff and service users were inclusive, Care Homes for Older People Page 31 of 40 Evidence: caring and respectful. Care Homes for Older People Page 32 of 40 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 7 15.1 To ensure that all service 01/01/2007 users have a written plan as to how their health and welfare needs are to be met. Care Homes for Older People Page 33 of 40 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The registered person must compile a statement of purpose that reflects the entire service provided at Ladybank, including all matters listed in Schedule 1 of The Care Homes Regulations 2001. In order that prospective service users have the information they need to make an informed choice about moving to the home and that existing service users are aware of the services provided by Ladybank. 18/12/2008 2 1 5 The registered person must 18/12/2008 produce a service users guide that reflects the entire service provided at Ladybank, including all matters listed in Regulation 5 (1) of the Care Homes Regulations 2001, as amended by The care Standards Act 2000 Care Homes for Older People Page 34 of 40 (Establishments and Agencies) (Miscellaneous Amendments) Regulations 2006. In order that prospective service users have the information they need to make an informed choice about moving to the home and that existing service users are aware of the services provided by Ladybank. 3 3 14 The registered person must 15/10/2008 ensure that comprehensive needs assessments are completed with all service users admitted to the home. In order that service users can be confident that the home can meet their needs. 4 7 15 The registered person must ensure that all service users have a written plan as to how their health, personal and social care needs are to be met. In order that service users can be assured that their needs will be met and that potential risks to their safety and wellbeing are identified and addressed. 5 18 13 The registered person must put systems in place to ensure that all staff, whether employed directly by the provider or employed by a person other than the registered provider, 01/10/2008 03/10/2008 Care Homes for Older People Page 35 of 40 understand and comply with the homes whistle blowing policy and the procedures in place for safeguarding adults. In order to protect service users from harm or abuse. 6 29 19 The registered person must 16/10/2008 ensure that all staff involved in recruitment are fully aware of, and adhere to, the requirements of the Care Homes Regulations 2001 as amended by The Care Standards Act 2000 (Establishments and Agencies) (Miscellaneous Amendments) Regulations 2004 and ensure that no person is employed to work at the home without all the required checks and documents having first been obtained. In order to protect the service users from the potential risk of harm or abuse. 7 29 19 The registered person must check all staff recruitment files for people employed since 26 July 2004 (including PCT staff) and ensure that all information and checks have been obtained as required of Regulation 19 and Schedule 2 of the Care Homes Regulations 2001, as amended by The Care Standards Act 2000 09/10/2008 Care Homes for Older People Page 36 of 40 (Establishments and Agencies) (Miscellaneous Amendments) Regulations 2004. In order to protect the service users from the potential risk of harm or abuse. 8 29 19 The registered person must ensure that written confirmation is obtained from employers other than the registered provider (e.g. for agency staff) that they have obtained the required information set out in the amended Schedule 2 of The Care Homes Regulations 2001, for each member of staff supplied. In order to protect the service users from the potential risk of harm or abuse. 9 32 10 The provider must review the organisation and management of the home. The organisational structure and accountabilities within the home must reflect that both Ladybank unit and Bridgewell unit are part of the care home registered as Ladybank and are one registered service with one registered manager. Clear lines of accountability must be established, recognising that the registered manager has overall responsibility for both units. 18/12/2008 09/10/2008 Care Homes for Older People Page 37 of 40 In order that service users can have confidence that the home is led and managed appropriately and in their best interests. 10 33 24 The registered person must implement an effective quality assurance and monitoring system in both units that is based on seeking the views of service users and/or their representatives. In order that service users can have confidence that the home is run in their best interests. 11 38 13 The registered person must implement a monitoring system for the whole home to ensure that any risks identified to the health, safety and welfare of the service users are promptly addressed. (This requirement also refers to Standards 7 and 8.) In order that the health, safety and welfare of service users is promoted and protected. 12 38 37 The registered person must 18/10/2008 notify CSCI without delay of the occurance of any incidents listed in Regulation 37 of The Care Homes Regulations 2001. 18/10/2008 18/12/2008 Care Homes for Older People Page 38 of 40 In order that the health, safety and welfare of service users is promoted and protected. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 It is recommended that each service user is provided with a statement of terms and conditions with the home, as set out in national minimum standard 2. It is recommended that the provider reviews the telephone system at the home to enable calls to be directed to the registered manager, whichever telephone number is dialled by the caller. 2 32 Care Homes for Older People Page 39 of 40 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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