Inspection on 15/06/07 for Puttenhoe

This inspection was carried out on 15th June 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Puttenhoe 10/01/06

Puttenhoe 01/11/05

Puttenhoe 06/01/05

Puttenhoe 02/09/04

Puttenhoe 02/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Puttenhoe 180 Putnoe Street Bedford Bedfordshire MK42 8AB Lead Inspector PursotamRaj Hirekar Unannounced Inspection 12:30 15th June 2007 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.V334746.R01.S.doc Version 5.2 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.V334746.R01.S.doc Version 5.2 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 345347 BUPA Care Homes (Bedfordshire) Ltd 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.V334746.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th January 2006 Brief Description of the Service: Puttenhoe was a purpose built care home for 29 service users. The home was situated in the Puttenhoe 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.V334746.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of the unannounced inspection carried out on 15/06/07 over 5 hours by Pursotamraj Hirekar. The acting manager coordinated the inspection through out. The method of inspection included study of care plans, risk assessments, personnel records, staff deployment duty rota, relevant care delivery documents, discussions with acting manager, staff, conversation with service users’ and partial tour of the building. This inspection report also includes information from annual quality assurance assessment – selfassessment carried out by the home. What the service does well: What has improved since the last inspection? What they could do better: The home must ensure that the care plan is updated to reflect changing needs of the service user. The home must ensure that records are kept of all medicines received, administered and returned by the home or disposed of, to ensure that there is no mishandling. Including, the information on the mar sheet and the medicine in store correlate as well. The home must ensure that all staff received supervision as part of the normal management process on a continuous basis. Puttenhoe DS0000014949.V334746.R01.S.doc Version 5.2 Page 6 The home must ensure the night shift, ratio of care staff to service users must be determined according to the assessed needs of the service users’. The home should ensure that the care plan is drawn up with the involvement of service user, agreed and signed by the service user whenever capable and /or representative. The home should maintain record of checks carried out for the entire water points, unit wise separately. 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. The summary of this inspection report can be made available in other formats on request. Puttenhoe DS0000014949.V334746.R01.S.doc Version 5.2 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.V334746.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home had made appropriate arrangements for the assessment of needs of the service users’ and the service users’ were aware of the care and services they would receive from the home prior to their admission. EVIDENCE: The home had made appropriate arrangements for the preadmission assessments of the potential long term and respite service users’, which included guided tour of the home, explanation about diet and staff support. Summary details of a service user on a random sample, service user –1 was admitted on the 13/09/06 and a preadmission assessment was carried out which covered aspects of presenting conditions, past medical history, personal care and physical well being, diet and weight, sight, hearing, oral health, foot care, mobility, history of falls, skin integrity, continence, medication usage, mental state and cognition, personal safety and risk, hobbies, religious and cultural, family and friends, and night sleep. The preadmission assessment also covered specialist social work assessment on the 22/08/06. Puttenhoe DS0000014949.V334746.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had made adequate arrangements for the delivery and care of the personal and health care needs of the service users’. However, the home must ensure that the service user and their family members participate in the preparation of the care plans and the care plan reflects changes as and when they occur. Also, the medication administration record must correspond with the actual medicine administered to the service user. EVIDENCE: It was observed on this inspection that the staff members respect the privacy of the service users’ and in helping them to maintain their dignity as well. The service users’ appeared clean, well dressed, and cheerful. The home had made appropriate arrangement in the preparation of care plans of service users’. However, The home need to provide evidence with regard to the participation of the service user and their family members in the preparation of the care plans including when changes were made. The home further needs to reflect changes in the care plan as and when any change occurs to the needs of the service user. On this inspection 4 service users’ were case tracked and found Puttenhoe DS0000014949.V334746.R01.S.doc Version 5.2 Page 10 that; 2 service users’ mar sheet and the medicine in store did not correlate. The home needs to maintain record of receipt and return of unused medicine. The summary details of 4 service users’ are as follows: Service user –1 monthly nutritional assessments were carried out that included weight and body mass index regularly. Manual handling assessments, the behavioural assessment scale of later life, including safe system were regularly updated every month. The safe system of work which covered bathing/washing, mobility, toileting, mealtimes, memory, orientation, communication, restlessness, cooperation, motivation, behaviour, personal care, fulfilment, decision making, reasoning sand logic, risk, hearing, sight and social relations were regularly monitored. The care plan’s sections of personal care, mobility, continence, diet, night, and rest, communication, social needs, and health were reviewed in the month of May 2007. Doctor’s medication review was carried out on the 15/05/07 and the changes were not reflected in the care plan. However, the date of receipt for Paroxetine medicine was not recorded. The mar sheet and the medicine available did not correlate and this was brought to the notice of the manger and senior staff, who agreed for immediate action. Service user – 2 had assessment of abilities within a residential home, which included bathing, mobility, toileting, mealtimes, memory, orientation, communication, restlessness, cooperation, motivation, behaviour, personal care, fulfilment, decision making, reasoning, risk, hearing, sight and social relations were reviewed regularly every month and the latest seen on this inspection was dated 28/05/07. Care plan was prepared on the 09/10/06 and the behavioural assessment scale of later life, body mass index, nutritional assessment, manual handling and falls risk assessments were regularly reviewed every month. The elements of care plan that covered personal care, mobility, social needs, dietary needs, and continence, personal safety, and risk and health were last reviewed on the 28/05/07. The risk assessments were reviewed as and when required and the care plan updated accordingly. Service user – 3 had assessment of abilities within a residential home was regularly reviewed every month and the latest review was dated 18/05/07. Risk assessments including safe system at work, falling over, manual handling, waterlow pressure score were assessed regularly every month. The elements of care plan that covered behavioural assessment scale of later life, cognitive and memory, personal care, skin care, continence, dietary, social needs, mobility, wastage meal or supplement were reviewed every month and updated as and when required. The medication administration record was seen and found that Sulfasalazine recorded as administered but the medicine was found in the strip for 06/06/07. This was brought to the notice of the manager and the staff on duty who agreed to take immediate action. Service user – 4 the elements of care plans that covered personal care, social needs, continence, mobility, night, scalp and face were regularly reviewed and Puttenhoe DS0000014949.V334746.R01.S.doc Version 5.2 Page 11 changes were reflected in the care plans. The home had carried out monthly care plan audit for safe system of work, assessment of abilities, behavioural assessment scale of later life, body mass index, manual handling, and falls risk assessment. Puttenhoe DS0000014949.V334746.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users’ dietary needs were assessed and choice of menu and timings were maintained, in the interest of the service users’. The service users were encouraged to have activities of their choice and interest. EVIDENCE: The service users’ dietary needs were assessed and choice of menu and timings were maintained, in the interest of the service users’. The home had carried out each individual service user assessment in relation to their daily life and social activities and had incorporated, the same into their care plan. Each service user had an activity profile detailing various activities that match the needs of the service user and a monitoring record of participation. The home also, had encouraged the family members and friends to have good relations with the service users. Summary details of 4 service users’, what they have done for the month of May 2007 is as follows: Service user –1 activity record for the month of May 2007 was seen and found out that she participated bingo, singing, knitting and met a friend. Service user – 2 went out for shopping, did gardening, listening to music, bingo, and visit to church. Service user – 3-activity report mentioned entertainment and self-engagement. Puttenhoe DS0000014949.V334746.R01.S.doc Version 5.2 Page 13 Service user – 4 had structured set of activities that revolved around selfengagement, bingo, clubroom, and children singing. Puttenhoe DS0000014949.V334746.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users’ were aware of the complaints procedure and were confident to use the same when necessary. EVIDENCE: The home had a robust complaints policy and procedure in place. One of the key features of the policy was an open door policy, where service users and their relatives were encouraged to talk to the management. The service users spoken to were aware of the complaints procedure and were confident to use the same when necessary. The home had made arrangements for monthly monitoring of complaints and the same was discussed in the staff meetings. The staff members have received training in safeguarding adults. The home did not have any allegations of abuse and no one was referred to SOVA register. Puttenhoe DS0000014949.V334746.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was maintained clean and tidy and the service users’ were happy about it. The home should provide evidence of all water points temperature check and at what frequency they were carried out. EVIDENCE: The home was maintained clean and tidy with out any offensive odours. The service users’ have utilised the choice of decorating their rooms and in arranging the room to emulate as near as possible the home environment. Most of the service users had their personal belongings in their rooms neatly decorated. The carnation dining area was refurbished with flooring, curtains, and furniture. The home had indicated in their annual quality assurance assessment – self-assessment that the various equipments maintenance and service was carried out as per the required schedule. Puttenhoe DS0000014949.V334746.R01.S.doc Version 5.2 Page 16 The weekly fire alarm test records seen on this inspection found they were maintained regularly. However, the home need to provide evidence with regard to all water points temperature checks and the frequency of checks carried out. Puttenhoe DS0000014949.V334746.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s policy on staff recruitment was comprehensive. The home needs to improve staff ratio with appropriate skill mix, to match with the current and changing needs of the service users’. EVIDENCE: The home was managed on a 3-shift staff system. Shift 1 had 6 staff working from 7.30am to 2.30pm, shift 2 had 6 staff working from 2.00pm to 9.30pm and shift 3 had only 2 staff working from 9.30pm to 7.30am for a total of 29 service users’. The home had indicated in their annual quality assurance assessment – self-assessment that there were 13 service users’ who are doubly incontinent, 18 service users’ with dementia and 9 service users’ who require 2 or more staff to help with their care during day and night. Given the above situation, the home may need to revisit the staff deployment ratio for the night shift to ensure that the service users’ don’t have to wait for receiving service when in need and the staffs attend promptly, especially during night shift. The home had implemented a robust recruitment policy and procedure. On this inspection 4 staff members recruitment records were seen, the summary of their details are as follows: staff – 1 had an application, CV, supervision agreement, induction, references and CRB. Staff – 2 had application, interview responses details, safeguarding adults’ check; staff induction, references, and CRB. Staff – 3 had an application, references and CRB. Staff – 4 had an Puttenhoe DS0000014949.V334746.R01.S.doc Version 5.2 Page 18 application, references and CRB. The home had carried out a detailed staff training needs assessment and developed a training calendar for imparting training. Some of the trainings that the staff members received in the past few months included manual handling, infection control, health and safety, food hygiene, first aid, fire safety, giving the best nutrition and understanding dementia. The home had required percentage of staff working with NVQ2 level qualification. Puttenhoe DS0000014949.V334746.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had maintained good standards of care delivery and good working relations with the service users’ and their family members, staffs and relevant professionals which had been useful for appropriate care delivery and in meeting the service users’ assessed needs. EVIDENCE: The home did not have a registered manager. The current acting manager was due to retire in a weeks time from the day of this inspection and the new manager was likely to join in July 2007. In the interim, a manager from the sister home was working as a link person. The inspector was informed that the home was also in the process of recruiting a new deputy manager. On this inspection 4 staff members supervision records were seen and found out that the bi-monthly staff supervision was not regular for example staff –1 Puttenhoe DS0000014949.V334746.R01.S.doc Version 5.2 Page 20 had last supervision on 14/02/07. Staff-2 had last supervision on 07/02/06. However the other 2 staff supervision was regular. Service users’ finances were not seen on this inspection. The assessed healthcare and personal needs of the service users’ were met with good standards as reported under various outcome groups of this report. It was observed during the interaction with the service users’ on this inspection that, the service users’ were neatly dressed, clean, and have expressed satisfaction with the care and services they received at the home. The home had indicated in their annual quality assurance assessment – self-assessment that the various policies, procedure sand code of practices that were in place. However, the date of last review was not presented. The manager had told the inspector on this inspection that the home will send across information with regard to all policies date of last reviewed. Puttenhoe DS0000014949.V334746.R01.S.doc Version 5.2 Page 21 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 X X 4 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 X X X X X 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Puttenhoe DS0000014949.V334746.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation Requirement Timescale for action 31/07/07 2. OP9 15 (2) (c ) The home must ensure that the (d) care plan is updated to reflect changing needs of the service user. 17 (1) (a) The home must ensure that Schedule records are kept of all medicines 3 (3) (i) received, administered and returned by the home or disposed of, to ensure that there is no mishandling. Including, the information on the mar sheet and the medicine in store correlate as well. 18 (2) The home must ensure that all staff received supervision as part of the normal management process on a continuous basis. 31/07/07 3. OP36 31/07/07 4. OP27 18 (1) (a) The home must ensure the night 15/09/07 shift, ratio of care staff to service users must be determined according to the assessed needs of the service users’. Puttenhoe DS0000014949.V334746.R01.S.doc Version 5.2 Page 23 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 OP7 Good Practice Recommendations The home should ensure that the care plan is drawn up with the involvement of service user, agreed and signed by the service user whenever capable and /or representative. The home should maintain record of checks carried out for the entire water points, unit wise separately. 2. 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