CARE HOMES FOR OLDER PEOPLE
Puttenhoe 180 Putnoe Street Bedford Bedfordshire MK42 8AB Lead Inspector
Dragan Cvejic Unannounced Inspection 10th January 2006 11:30 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.V277559.R01.S.doc Version 5.1 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.V277559.R01.S.doc Version 5.1 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.V277559.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st November 2005 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 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.V277559.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that focused on the main points to indicate outcomes for service users. It was carried out during 3 hours during the midday period. The senior staff on duty and the manager accommodated and facilitated the inspection. Nine service users spoke about the home and two gave detailed feedback about their life in the home. A visitor also commented on his view of the home in general and on the care provided to his relative. A member of staff confirmed the statements provided by other contributors to the inspection. The inspection demonstrated that the home continued to provide well organised, structured and sensibly delivered standards of care. What the service does well: What has improved since the last inspection?
Puttenhoe DS0000014949.V277559.R01.S.doc Version 5.1 Page 6 The manager just had completed her Registered Manager’s Award training and gained that qualification. At the beginning of the inspection, she was providing training to staff on how to use a new hoist that had just been bought and delivered. She then walked through the home to see all service users in person and chatted to them in a friendly and supportive manner. The manager investigated a complaint and introduced a new procedure for staff accompanying service users to hospital. She analyzed details and comments from quality assurance survey and was drawing up an action plan, addressing the areas identified by service users that could be improved. The change of management of wheelchairs within the NHS was analyzed and the manager investigated who the wheelchairs belonged to in order to ensure that all users who need wheelchairs have one. As a part of this process, the list of personal belongings in users’ files was reviewed and updated, after it was discussed at the users’ meeting. A new carpet was laid down, one unit was completely re-decorated and a safety film was put on all windows. The state of the environment was constantly monitored and actions were taken to maintain standards and ensure the safety of service users. 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.V277559.R01.S.doc Version 5.1 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.V277559.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,5 The appropriate preadmission assessment and the trial visits and period facilitated making the right decision about the choice of home by service users, relatives, professionals involved and the home themselves. EVIDENCE: The needs assessment was done by the manager who involved service users, relatives, other external professionals and consulted staff and other, existing service users when the admission progressed to the level of decision making. The format used for assessment included all relevant aspects of care and of the needs of potential service users. The trial visits and the trial period provided an opportunity for service users to decide if the home offered what they were looking for. A visitor confirmed that he was well informed and clear about expectations when the decision for his relative was made. He continued, saying that all assessed needs were met and that regular reviews ensured that any change was identified and appropriately addressed. Puttenhoe DS0000014949.V277559.R01.S.doc Version 5.1 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, 10 The health care needs of service users were met and were promoted. Service users and relatives expressed satisfaction and appreciation of the home’s practices to protect and ensure service users health needs were met. EVIDENCE: The manager showed how the care needs were met, citing the example of dealing with pressure sores for a service user, that were addressed on time, treated appropriately by the district nurse and the home’s staff and were almost healed completely at the time of the inspection. A new hoist was delivered a day prior to the inspection and on the date the manager trained staff on how to use the hoist effectively. A visitor explained that all healthcare needs of his relative were appropriately dealt with. Observation of staff dealing and helping a service user demonstrated that actions were taken appropriately. An anxious service user found a “safety net” in the hands of her key-worker when the appearance of the inspector’s face, unusual for this user, caused a level of anxiety. Staff knew her needs well and explained all to the inspector. Puttenhoe DS0000014949.V277559.R01.S.doc Version 5.1 Page 10 Observation showed that privacy of service users while receiving personal care was respected. A staff member politely asked the inspector to wait outside the room while she finished with personal help to a service user. A visitor and his relative both commented that service users’ privacy was highly respected. Puttenhoe DS0000014949.V277559.R01.S.doc Version 5.1 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 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 visitor commented that his relative was not keen on joining organised activities, although there were plenty of opportunities. In further discussion, it became clear that his relative enjoyed regular visits of the nurses who were bringing in guided dogs to allow service users contact with pets. She also enjoyed the company and movements of staff around her. A staff member was seen moving in the area where this user sat. In another lounge four service users were playing with puzzles. They stated that activities were appropriate for their abilities, preferences and expectations. Meal times were relaxed and unhurried. A service user took a long time to move independently to the dining room and commented to a fellow user: “I managed. I managed to get here on my own”. Her smile was a reward to the staff member who patiently and sensibly observed her while she was walking to the dining room.
Puttenhoe DS0000014949.V277559.R01.S.doc Version 5.1 Page 12 Minutes from the users’ meeting showed their discussion on the choice of colour for the recently re-decorated lounge. The result of the choice was proved in the comment of a service user: “This is a lovely colour in this lounge, isn’t it? We chose it.” All users and a visitor stated that the food was very good and that a good choice was offered. Puttenhoe DS0000014949.V277559.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 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 home’s records of complaints contained the outcome of the last complaint received in the home, which demonstrated how the home was effectively using complaints to improve service. A new, better procedure for accompanying service users to hospital appointments was devised as a result of the complaint. The home did not have any allegations of abuse and no one was referred to POVA register. Service users that needed help and support with their finances were supported through the already established BUPA system, which ensured high protection of service users. Puttenhoe DS0000014949.V277559.R01.S.doc Version 5.1 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): 19,20,22 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: The home was clean and bright and an enjoyable place to live in. A visitor stressed how pleasant the atmosphere in the home was and many service users commented even to him how they enjoyed the homeliness and friendliness of the home. The home was accessible throughout to all service users. It was recently inspected by the fire authority and confirmed to be safe. Communal spaces were created not only in the lounges and small dining rooms, but also in the bright and airy widenings in the corridors where service users enjoyed privacy to be with one more person. Majority of service users chose to eat in smaller dining rooms in their units. The replaced furniture and re-decorated unit looked very nice and homely, especially with a new carpet that was laid since the last inspection. Two bedrooms inspected contained specialist beds. A lounge where several service users spent their daytime had two specialist reclining chairs. A new hoist, much more comfortable, was delivered the day before the inspection and
Puttenhoe DS0000014949.V277559.R01.S.doc Version 5.1 Page 15 the manager provided training to the staff on how to use it on the day of the inspection. The manager was making a list of the wheelchairs in order to identify any extra, or any not allocated to individual service users and to negotiate the use of wheelchairs with the local NHS service. The problem with the old type window frames was addressed, some windows were replaced and all glass on windows was fitted with safety film, increasing security and safety. Puttenhoe DS0000014949.V277559.R01.S.doc Version 5.1 Page 16 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): 29,30 The manager ensured that by full respect of the recruitment procedure, the service users were protected. Regular training also contributed to the good care offered to service users. EVIDENCE: The manager stated that all new staff were going through a strict and detailed recruitment procedure, as directed by the BUPA recruitment procedure. A staff member returning to work after a break in her career, confirmed that all checks were done again prior to the offer of employment being made to her. Staff attended all mandatory training, including refresher courses. The manager arranged for night staff to attend medication training and improve their knowledge of medication, as they were in the position to deal with medication prescribed on a “when needed” basis. Puttenhoe DS0000014949.V277559.R01.S.doc Version 5.1 Page 17 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): 31,32,33,35 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 manager had settled into her position and her skills and experience reflected an open and creative management style. All staff were clear of their roles. Rota was clear and designed to ensure that daily routine could easily be followed. The manager completed her RMA training and kept all other training up to date. She was providing training to staff too. A survey was organised as a part of the quality assurance review and the manager was just assessing the results and preparing an action plan. She was fully aware that the plan would need to be forwarded to the regulation authority. She also stated that a meeting was booked where the feedback from the survey would be provided to participants.
Puttenhoe DS0000014949.V277559.R01.S.doc Version 5.1 Page 18 Service users who needed help with their finances and money were helped through the established and secure BUPA financial system. Puttenhoe DS0000014949.V277559.R01.S.doc Version 5.1 Page 19 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 4 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 X X X Puttenhoe DS0000014949.V277559.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? 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. Refer to Standard Good Practice Recommendations Puttenhoe DS0000014949.V277559.R01.S.doc Version 5.1 Page 21 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
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