CARE HOMES FOR OLDER PEOPLE
Puttenhoe 180 Putnoe Street Bedford Bedfordshire MK42 8AB Lead Inspector
Dragan Cvejic Unannounced Inspection 1st November 2005 07:30 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 Puttenhoe DS0000014949.V263345.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. Puttenhoe DS0000014949.V263345.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Puttenhoe Address 180 Putnoe Street Bedford Bedfordshire MK42 8AB 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) 01234 261396 01234 347345 BUPA Care Homes (Bedfordshire) Ltd Mrs Fleur Sharman Care Home 29 Category(ies) of Dementia - over 65 years of age (29), Old age, registration, with number not falling within any other category (29), of places Physical disability over 65 years of age (29) Puttenhoe DS0000014949.V263345.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 06/01/05 Brief Description of the Service: Puttenhoe was a purpose built care home for 29 service users. The home was situated in the Putnoe area of Bedford, within walking distance of shops and services. The home was offers accommodation in en-suite bedrooms. The practical division of the home into three working units made the home more personalised and increased respect for service users individuality. The home accommodated people who have physical disabilities, dementia, or the frailty of old age. The home had respite care beds as well as “breather” beds. The “breather” beds were used in a variety of circumstances where the service user needed time in an organised care environment, for example when their home needed adaptations fitted, or if they needed to gain confidence in the management of their medical condition. Some service users were admitted straight from hospital or from their own homes. The home was visited by HM the Queen in 1976 and had this fact displayed in their main foyer. Puttenhoe DS0000014949.V263345.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. It started in the early hours of the morning and finished 4.5 hours later. Three service users were case tracked, meaning that their documentation and way of life was inspected. Four more service users spoke to the inspector, as well as three staff members. Three service users’ files were checked, containing care plans, risk assessments and other relevant documents about each individual. A tour around the building provided a clear picture of the state of the home. What the service does well:
On the arrival to the inspection a gentle Beetles song was filling the foyer with pleasant sound. The foyer was very comfortable, with many ornaments and photographs creating a very homely environment. Fresh flowers and plants in pots refreshed the area. A service user, a bit confused, approached staff asking for towels taken for washing the night before. Further down the corridor, there was a comfortable small kitchenette and dining area. Another service user sat comfortably with a cup of tea. A staff member, working in this unit, checked what a user wanted for breakfast and prepared toast with marmalade. The staff member stopped patiently allowing the to service user time to remember what she was going to say, before she took a cup of tea to another user who opted to stay a bit longer in her bedroom. “God bless you, you are so good”, she praised the staff. Her needs had changed since her admission, as was recorded in the admission assessment document and her currently reviewed care plan. She confirmed that she had asked staff to help her with the pressure mat, to prevent any potential fall. A pressure mat was connected to the bleepers carried by staff and alerted staff when there was a risk. Since this measure was put in place, the number of falls has significantly dropped. A notice board contained the complaints procedure, information about activities, a show planned with a visiting entertainer, information about the forthcoming Christmas, an extract from newspapers about the latest research article about Alzheimer’s disease and the explanation of the Avian influenza (“bird flu”) that has recently threatened Britain. A representative from social services was invited to attend a staff meeting booked for a later time on the day of the inspection to talk to staff about the role of social services in the care process and protection of vulnerable adults. Another service user described the home by saying: “It is lovely here, it feels like home. We have a lovely life here.” Puttenhoe DS0000014949.V263345.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Puttenhoe DS0000014949.V263345.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 Puttenhoe DS0000014949.V263345.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): 1,2,3,4, A statement of purpose provided clear information to potential and existing service users about what was provided by the home and included information as to what was included and what was payable extra and was not covered by the fee. This way, service users knew what to expect if they chose this home. EVIDENCE: A statement of purpose stated that on top of the regular organised activities, service users could choose to pay for and take part in special chair exercise provided by specialists, while the home’s amenity fund paid for a music therapist. The initial assessment forms were in each user’s file and were used as a source of information for creating individual care plans. The format was created from the Care Standards Act list and covered all aspects of life and care needs. The home continued to regularly review assessment of abilities and have an up to date overview of each individual abilities and corresponding care plan and risk assessment. These documents were used for care process that, as confirmed by several service users spoken to, ensured that service users’ needs were met. A staff member appropriately acted with an individual service user affected by dementia. She stopped and allowed time for the user to finish the thoughts
Puttenhoe DS0000014949.V263345.R01.S.doc Version 5.0 Page 9 suddenly disrupted by the illness. This observed action was not only appropriate for dementia condition, but was so gentle, sympathetic, friendly and human. The service user looked so happy that she had got this extra time needed to formulate the thoughts to the end. A food intake chart in user’s files demonstrated how the home dealt with weight loss and prevented further deterioration in health for two inspected service users. All health care needs were addressed in care plans and several actions observed during the inspection demonstrated that staff and users knew and respected the plans. Puttenhoe DS0000014949.V263345.R01.S.doc Version 5.0 Page 10 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): 7,8,9,10 The health care needs of service users were met and were promoted. The care plans and other documents kept in the home about service users evidenced through their accuracy that the home had an approach by which individuality, privacy and dignity were respected and promoted. EVIDENCE: A care plan was generated from the initial assessment and continuous assessment of abilities. Users preferences were recorded and incorporated into care plans. One of the inspected files stated that a service user very much liked to go out for a walk. When spoken to, she confirmed that staff were taking her out: “”They take me out, on the whole, they are very, very good.” All users’ documents were regularly reviewed and updated. Risk assessments were related to care plans. A user was assessed with a high risk of falls in the morning. Her care plan instructed two workers to help her get up, a pad mat was introduced to minimise the risk, and the review showed a significant drop in the number of falls. Service users health care needs were appropriately dealt with and ensured the well being of service users. Nutritional charts for two users indicated how the home monitored their weight until it was stabilised, on three occasions.
Puttenhoe DS0000014949.V263345.R01.S.doc Version 5.0 Page 11 The home reviewed medication practice and introduced measures to improve accuracy after an incident when a tablet was wrongly administered. This was reported, investigated and a number of measures introduced to minimise the risk of reoccurrence. Service users privacy and dignity were highly respected, as observed during the inspection. Puttenhoe DS0000014949.V263345.R01.S.doc Version 5.0 Page 12 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): 12,13,14,15 The home offered varied and stimulating activities, after identifying service users preferences and suggestions, some payable as extras, but meeting users needs and preferences was considered to be more important than money. The daily life and routine suited service users who were in a position to influence decisions about these matters in the home. EVIDENCE: A variety of activities organised and offered in the home were established from the recorded users’ preferences. An extra payable activity, a chair exercise, was provided by a specialist. Music therapist was funded from the home’s amenity fund. Service users’ preferences were recorded in detail and included the preferred member of staff that each individual wanted to support and help them. In one case, this was incorporated into a care plan. The notice board provided information about local facilities and available advocacy service. A very nice and comfortable visitors room was situated on the first floor and freely used by service users when they wanted to see visitors in private. A payphone was installed in a glassed area in the home to offer more privacy. One of the case tracked service users kept her money and was provided with the key for a lockable drawer where she stored her personal valuables. Care
Puttenhoe DS0000014949.V263345.R01.S.doc Version 5.0 Page 13 plans indicated if service users were not able to handle their finances and did not have the ability to effectively use the key. An example of choice of food was observed. A staff member asked naming, a service user: “What would you like for breakfast?” The service user expressed her wish and this choice was soon served for her. Service users were also offered the option to eat where they wanted. Puttenhoe DS0000014949.V263345.R01.S.doc Version 5.0 Page 14 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): 16,18 The home had an effective complaint procedure and the manager was committed to listening to and to taking seriously any potential complaint or concern, thus ensuring good protection of service users. EVIDENCE: The complaints procedure was displayed in various places around the home and was available to anyone who would like to make a complaint. The home had not receive any complaints since the last inspection. Protection was promoted within the home. A revised whistle blowing policy was displayed in the staff room. Puttenhoe DS0000014949.V263345.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): 19,20,22,24,26 The home was a nice place to live in. It was arranged in a homely style and was suitable for the service users and their needs. It was well maintained. EVIDENCE: Not only the location of the home, but the organisational structure: keeping the dementia unit on the ground floor, benefited all service users and staff. The freedom of independent movement through the home was facilitated by this arrangement. The enclosed garden was open to all. The stairs and lift to the first floor also did not have any limiting or restricting obstacles and were used independently by service users who were able to use them safely. All communal areas in the home were nicely furnished and arranged in a homely manner. Bedrooms of case tracked service users were comfortable, with pieces of personally brought furniture items, ornaments and photographs. Bedrooms were lockable and the lockable drawers were part of the provision offered in the home. The entire home provided a homely environment and service users enjoyed the type of furniture and the arrangements in communal areas and in their rooms. Puttenhoe DS0000014949.V263345.R01.S.doc Version 5.0 Page 16 The home was bright and clean. A laundry room was away from the kitchen and other communal areas used by service users and positioned in a way to promote infection control measures. Puttenhoe DS0000014949.V263345.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): 27,28,30 The home employed a well balanced staff team with skills and experience that allowed them to meet the needs of service users. Regular, appropriate training, supervisions and the atmosphere in the home affected the satisfaction and commitment of staff who were meeting the users needs. EVIDENCE: The inspection showed that there were enough competent and skilled staff in the home during the inspection. Staff spoken to stated that, generally, the home was sufficiently staffed. A service user gave the same general comment and added: “They are so nice. They are always present when we need them.” A staff member case tracked was observed working in her unit. She demonstrated a good level of knowledge of service users, of methods to deal with users’ conditions, of her awareness of safe working practices, and above all, of her human, friendly, supportive and positive influence on service users. Her training records showed that she had attended 7 different training courses. She was on the NVQ programme that corresponded to her abilities and preferences. The manager stated that NVQ training would culminate in March, when the majority of current attendants were expected to achieve qualifications and the home would achieve 50 of NVQ trained staff. Training was appropriate and regular and helped staff to skilfully respond to service users needs. Puttenhoe DS0000014949.V263345.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): 31,32,35,36,37,38 The home was well managed by the new manager. Service users’ safety, welfare and rights were protected. Their voice was taken into account when the management of the home was planned and organised. EVIDENCE: The new manager in post for the last six months had the skills, knowledge, enthusiasm and strength to lead the staff team through some minor changes and improvements without affecting the service provided to service users. She had recently completed her registration with the regulation authority. The atmosphere in the home was friendly, open, inclusive and homely. The staff were clear of their roles and expectations. A case tracked staff member showed good knowledge, skills and passion while working with service users on her unit. Service users spoken to seemed relaxed and free to express anything they wanted. The ethos and atmosphere in the home were commendable and exceeded minimum required standards. Several service users capable of doing so kept their personal allowances with them and managed them. A majority of users used the facilitated BUPA
Puttenhoe DS0000014949.V263345.R01.S.doc Version 5.0 Page 19 procedure where their money was held in an account with individual entries and balances. The statements and balances checked were correct. Staff were supervised regularly and, when spoken to, confirmed that supervision sessions met their needs. Records checked were up to date and regularly reviewed. Mandatory and other training was regularly organised and offered to staff. A case tracked staff member had all her mandatory training updated and had attended several other sessions. Observation of safe working practice confirmed the competence of staff. Puttenhoe DS0000014949.V263345.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 3 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 X X 3 3 3 3 Puttenhoe DS0000014949.V263345.R01.S.doc Version 5.0 Page 21 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard 18 Good Practice Recommendations The home should keep an up to date list of service users’ possessions brought in the home to ensure protection of potential abuse. Puttenhoe DS0000014949.V263345.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Puttenhoe DS0000014949.V263345.R01.S.doc Version 5.0 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
