CARE HOMES FOR OLDER PEOPLE
St Bridgets 14 East Avenue Talbot Woods Bournemouth Dorset BH3 7BY Lead Inspector
Debra Jones Unannounced Inspection 18th April 2007 10:00 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 St Bridgets DS0000020497.V336750.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. St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Bridgets Address 14 East Avenue Talbot Woods Bournemouth Dorset BH3 7BY 01202 291347 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) Mr A L Howell Mrs Joanna Ethne Hills Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12) of places St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home may accommodate a maximum of 2 persons in Room 23. Date of last inspection 23rd May 2006 Brief Description of the Service: St Bridget’s home accommodates 12 older people in need of nursing care in a large converted house. It is on a corner plot set back from the main road, in mature gardens with a small car park to the rear of the premises. The home is in the residential area of Talbot Woods within easy reach of shops, bus routes and community facilities. The residents accommodation is arranged over the ground and first floor. A passenger lift is available between floors. Four of the bedrooms are single and 4 are double. None of the bedrooms have ensuite facilities but there are communal bathroom and toilet facilities on the ground and first floor. At this visit the manager said that current fees for this home range between £550 and £650 a week. St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over two days and was the home’s key inspection for the year. The 3 requirements and 6 recommendations made at the last inspection were followed up to see if the home had made any progress towards meeting them. One requirement had been addressed. The Inspector looked around the building and a number of records were reviewed. On the first day the nurse in charge assisted the inspection and on the second the Matron was on hand to help. Residents living in the home were spoken to, along with staff on duty. What the service does well:
St Bridget’s aims to provide a ‘home from home’ atmosphere and does so successfully in a house decorated and furnished in a homely way. The home is kept clean and smells pleasant. Before residents move into the home they are visited and assessed to see if the home can meet their needs. Records are made of these assessments which then go on to inform the care plans. Residents health needs are well met by the home and community health professionals. Generally medication is well handled at the home to promote the health and well being of residents. Residents are well cared for and treated with respect and dignity. Some activities are available and residents can join in as they wish. People are free and encouraged to spend their days as they choose. Residents are able to see visitors when they wish and make decisions about how they spend their days within the constraints of a residential care home setting and their own abilities. Meals are wholesome and varied and planned around the likes and dislikes of residents. The complaints procedure reassures residents that their views are important to the home and that any complaints they, or their supporters raise will be properly investigated. The home has an adult protection policy and staff have received training in this area to ensure the protection of residents. St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 6 The home has a good committed manager and sufficient care staff are employed to meet the current needs of residents. Staff have access to the basic training that they need to do their jobs. The manager supervises staff at the home on a daily basis. They also have the opportunity to sit down with her regularly to talk about their work and what training they need to do their jobs better in order to provide a better service to the residents. The home is not involved in the finances of residents. The home is regularly checking their fire equipment and keeping appropriate records of this. Staff are appropriately trained in fire safety. Accident records are also kept, regularly analysed and actions are taken to reduce the risk of accidents happening again. What has improved since the last inspection? What they could do better:
All of the requirements and recommendations made in this report have been made at previous inspection visits; some more than once. The home need to make sure that they undertake a manual handling assessment for all the residents living at the home and that this assessment if regularly reviewed. Where equipment is introduced that restrains the movement of residents, for example bed rails, the home needs to carry out an assessment to confirm the use of the equipment is in the resident’s best interests. Once undertaken this assessment must be regularly reviewed. Care plans also need to include a section on how the home will meet the individual resident’s medication needs. When there is a change to a medication administration record e.g. if something is added or a dose changes; 2 competent people should check that the change that is made is correct and both should sign to confirm this. The home should produce a programme of maintenance and renewal in respect of the premises and this must include the requirements that the Commission has said that the home must comply with e.g. restricting the temperature of water in the wash hand basins that residents have access to. The home must also produce written risk assessments in respect of individual residents and any dangers posed to them by radiators and pipe work around the home. Some radiators that have been identified as posing a risk to residents remain uncovered / unguarded.
St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 7 It would be good if the home got someone who had the right professional training to carry out an assessment of the premises to confirm that it was suitable for the people living there. It would also be good if more care staff had an NVQ level 2 qualification in care. This would make care staff more knowledgeable about the job they do and potentially improve the quality of care delivered to residents at the home. Documentation must be in place to evidence that the home have followed thorough recruitment processes e.g. having 2 written references and a full employment history. It would be good if all staff were issued with terms and conditions of their employment. An annual survey of residents’ views must be carried out. Other people who visit the home also need to be asked what they think about it in order to improve services for the residents. The home must then pull all the responses together, add this information to other information they have collected about the quality of their service and write, and make available, a report about the quality of service at the home. In addition some good practice suggestions have been made throughout this report, some for the second time. These include:Carrying out self audits of the home’s medication system; Recording more about the lives of residents, their social histories and interests to inform the activities programme at the home, including time spent 1-1; The cooks at the home attending training about nutrition and older people; Locating the local ‘no secrets’ adult protection guidance and keeping it with the policies and procedures; Reviewing the data product file to make sure that it is up to date. 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.
St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 8 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 St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 9 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, 4 and 5. Standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A thorough pre admission procedure is in place and assessments are undertaken to ensure that only residents whose needs can be met by the home are offered places there. EVIDENCE: Files for two residents who had recently moved into the home were examined. One resident had moved as a matter of urgency from another home that may close. The resident was visited in the other home and the pre admission assessment was carried out there with the involvement of the resident, staff and records. The residents’ family visited St Bridget’s to look at the vacant room and general facilities prior to the decision to move to the home being made. The resident’s file contained a thorough pre admission assessment. The home had also obtained up to date information from the local authority. Due to
St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 10 the speed of the placement the home had not yet put in writing to the resident that the home could meet their needs. The other file, for a resident who had been at the home slightly longer, also contained a pre admission assessment and a letter confirming that the home could meet their needs. The registered manager had visited them at home, their neighbour had visited St Bridgets. Again the placement had been made quickly due the circumstances of the prospective resident. St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 11 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 good. This judgement has been made using available evidence including a visit to this service. There is a clear care planning system in place to make sure that staff have the information they need to meet residents needs. The health needs of the residents are well met with evidence of good support from community health professionals. The medication at this home is generally well managed promoting the good health and well being of residents. Residents are treated with respect and their right to privacy upheld. St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 12 EVIDENCE: Care plans reviewed at the inspection visit were comprehensive. Plans were easy to read, to the point and informative. They clearly set out individual care needs and how they are to be met. For example one resident is being peg fed and the plan had a section dedicated to this. Another resident is diabetic and her blood sugar levels fluctuate widely. This is clearly documented and the care plan sets out how staff are to manage her diabetic care. Plans are clear about what residents can do for themselves and what staff need to assist them with. The plans are reviewed regularly and updated as needed. Care plans seen referred to staff needing to assist residents with moving and handling equipment but care files still did not include manual handling assessments. Some residents have bed rails and bumpers on their beds that are used to keep them safe when they are in bed. Again these were referred to in the plans and permissions are sought from relatives but similarly there were no assessments as to why they were being used for that particular resident or risk assessments covering their use. It is considered good practice to include the medication needs of residents in care plans. This is not done routinely, although there some references to medication in the general care plans. Where it is particularly important to do this is in the case of the resident who has a medicine which is to be administered ‘when required’ but is unable to say when she requires it. The administration of the medicine is therefore at the discretion of the nurse on duty and there are no clear written guidelines for the nurses at the home as to when it is appropriate to administer the medicine or when to withhold it. For another resident who is being peg fed her medication is being administered as part of this feed. This is referred to in the care plan but not in sufficient detail i.e. staff are having to crush some of her medication. This is generally against good practice but due to the nature of the medication in this case it is acceptable. That this has been considered and is appropriate should be covered in the care plan to reassure staff, the resident and their representatives. Care plans and assessments are not demonstrating that residents or their representatives are involved in their development or review. Daily notes support and evidence the delivery of care to residents. Care plans, accident records and daily notes all cross referenced. St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 13 Most residents were not able to talk about the care they received but all spoken to smiled and those able to express themselves said they were well looked after, one gave a thumbs up sign when asked. It was clear from discussions with staff at the home and from documentation on file that residents have access to the health services they need. ‘We are lucky with our GPs.’ There was evidence to show that residents get support from General Practitioners, chiropodists, opticians and dentists. No residents are administering their own medication. One resident came from hospital with a pressure sore that is being treated. Another resident has a severe skin complaint. The local tissue viability nurse supports the home in delivering wound care through visits and being available by phone for advice. Medication at the home is only administered by the qualified staff who are all confident in carrying out this task. Samples of their signatures are held at the front of the medicines file. Photographs of residents are also kept on this file, though there were not photographs for the residents most recently admitted. Medicines and dressings were tidily stored in appropriate places e.g. the medication cupboards and the trolley. No controlled drugs are currently in use. Some medicines are being kept in the fridge in the medication room, the temperature of the fridge is regularly checked and the reading recorded. A system is in place for the disposal of medicines that are not used at the home and records are kept. Details of any residents’ medicine sensitivity or ‘none listed are noted on the medication administration records. Where there is a choice of dose of medication it is noted how much is actually given. Some hand written changes to the medication administration records made by staff at the home had not been signed by two people. (This was also the case at the last inspection in May 2006) Staff record the date that medicines are opened/ brought into use. A spot check of medicines showed that records could confirm how much medication was on the premises. At the last inspection visit in May 2006 it was suggested that the home audits themselves in respect of their medication administration. This good practice suggestion has not been adopted. Staff were seen treating residents with respect. Where residents share rooms their privacy is not compromised as fitted curtains across rooms provide screening when needed. St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 14 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. Residents’ lives are enriched by the social opportunities afforded by their visitors, activities at the home and the choices they are able to exercise day to day. The meals in this home are wholesome and varied and are served in a pleasant environment. EVIDENCE: As part of the assessment process residents are asked about their interests, hobbies, social and family networks and religious needs. These are then incorporated into the care and how residents like to spend the day is noted e.g. ‘likes dominos, knitting, puzzle books and 1-1 interaction.’ The information contained in the assessments and care plans seen was brief and did not give a full picture of the person and the lives they had lived before they moved into the home. It is suggested that this how social histories and
St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 15 interests and how the home plans for meeting residents’ social needs is revisited. Staff were far more knowledgeable about residents in conversation. The home organises some activities for the residents. There is a regular exercise class and occasionally entertainers come to the home. Residents can choose whether to join in or not. The home arranges for daily newspapers to be delivered to any residents who want to buy them. A hairdresser visits about every 10 days. Residents have radios and televisions as they wish in their rooms. The visitors’ book confirmed the number and range of visitors to the home. Residents are encouraged and supported in making choices about their daily lives. They are able to get up and go back to bed when they wish; have what they want to eat and drink, where and when they want it; spend time in the communal area / their bedrooms as they choose; do as they wish in the day and see visitors as it suits them. Staff are made aware of the importance of respecting the individuality of residents from their induction onwards. The meal served on the day of inspection was gammon to be served with leeks in a cheese sauce and swede. The alternative was fish fingers. This was to be followed by homemade apple crumble or jelly, suitable for those with diabetes. Fresh juices are available and on offer throughout the day. Menus are based around the known likes and dislikes of the residents. Special diets are being catered for e.g. one resident does not eat meat and two residents are diabetic. Where residents have poor appetites staff try to encourage residents to eat well and offer alternatives to tempt their appetites. The cook on duty was very clear about who liked what to eat and how they liked their meals to be served. No budget is imposed on the purchase of food at the home and residents can have what they like. Records are kept of the meals provided and individual records are held for residents as to what they have to eat each day and their general appetite. The home has a ‘nutritional assessment tool’ should they need to use it if they were concerned about a resident. It is again suggested that the cooks are offered the opportunity to have training in nutrition for older people. St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 16 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. A system is in place to deal with any complaints that might be made by residents. The home’s adult protection policy demonstrates an understanding of abuse and of how residents are to be protected from it. EVIDENCE: The home has a suitable complaints policy / procedure that is available to residents and their supporters. No complaints have been received by the home since the last inspection or by the Commission. The home has an adult protection policy to guide staff as to how to recognise signs of abuse and to tell them what to do about it if they do. It was suggested at the last inspection that the home keep the local (Dorset) guidance ‘No Secrets’ in respect of adult protection with this policy for easy reference. This had not been done and the guidance could not be found. Abuse training for staff is ongoing. St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 17 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, 22, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate facilities are available to meet the number of the current residents. Residents enjoy living in a clean and pleasant smelling home. Steps need to be taken to confirm that the home is suitable and safe for residents. EVIDENCE: A programme of routine maintenance and renewal of the fabric and decoration of the premises has not been produced, although there is evidence of ongoing refurbishment and redecoration. Since the last inspection new windows have been fitted in a number of bedrooms. St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 18 In addition the second lounge / dining area has been converted into a bedroom. This new bedroom and another bedroom on the ground floor have had new windows and patio doors fitted that lead out to the gardens. There are now 4 single bedrooms and 4 shared bedrooms in the home. The remaining large lounge is now also used as the dining area. This is an attractive and comfortable room on the ground floor that overlooks the garden. Residents confirmed how pleased they are with the improvements to the home. Residents are able to bring personal possessions into the home with them. There are an adequate number of communal bathrooms and toilets, with aids and adaptations, available in the home for the number of residents living there. There is a bathroom on the ground and one on the first. Most residents and staff prefer using the ground floor bathroom, but the upstairs one remains available. All bedrooms now have suitable coverings at their windows. The home has not been assessed by qualified persons, including an occupational therapist to see if the premises are suitable for the residents living there. The temperature of the water in the baths is controlled but not the hand basins in residents’ bedrooms or the communal bathrooms. In respect of this it has been required at previous inspections that to prevent risks from scalding pre set valves, of a type unaffected by changed in water pressure and which have fail safe devices, be fitted to provide hot water close to 43 degrees centigrade. This has not been done. The temperature of water coming from the tap in a hand basin in a communal bathroom was in excess of that considered safe. Radiators in the home were originally risk assessed in 2003. Of those identified as putting residents at risk at that time 7 remain uncovered / unguarded. The manager said that those that had posed the greatest risk had been covered. The pipe work at the home has not been included in any risk assessments. How at risk individuals living at the home are from radiators and pipe work has not been assessed. The home was clean and odour free. The laundry is appropriately sited. Suitable washing machines and sluices are in place. St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 19 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. Sufficient, suitably trained nursing and care staff are employed and deployed to ensure that the care needs of residents can be met. Not all appropriate documentation in relation to staff employed at the home is kept to demonstrate that residents are not at risk from unsuitable people working there. EVIDENCE: Clear staffing rosters are in place that show who is on duty and when. A qualified nurse is on duty at all times. Two health care assistants are on duty between 8am and 8pm and one health care assistant is on duty at night. In addition a cleaner works at the home 5 days a week in the mornings and there is a cook on duty 7 days a week. The matron, who is also the registered manager of the home gets 6 hours a week of dedicated management time. Two of the 11 health care assistants employed at the home have obtained their NVQ level 2 in care and 3 other staff are working towards the qualification. St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 20 The file of the only member of staff reported as having started work at the home since the last visit was reviewed. The file was well ordered and contained the following information required by law– • Proof of Identification • Criminal Record Bureau Disclosure (CRB) • Self declaration of criminal offences • Self declaration as to mental and physical fitness • Permission to work • When they started working at the home The file only contained one acceptable reference rather than the 2 required by law. There was no history of employment on file. It remains the case, as at the last inspection that not all staff have been issued with statements of terms and conditions (of employment). The recruitment procedure is in need of updating e.g. a full employment history must be obtained from any prospective employees and any gaps in employment should be discussed and documented. Whilst there was evidence that staff are getting a comprehensive induction, it could not be demonstrated that the Skills for Care induction package (the new ‘industry standard’) was in use. An overview of the training that staff have had is kept by the manager. Staff have access to training such as emergency aid, health and safety, food hygiene, moving and handling and abuse. Since the last inspection visit staff have had manual handling and abuse training. Qualified staff have continued to keep their practice up to date by attending locally organised workshops. In house informal discussions are held in respect of the conditions of the residents e.g. all staff have had instruction about peg feeding. St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. The home is not entirely protecting residents in respect of their health, safety and welfare of residents. The home does not have a formal quality assurance system to show that St Bridgets is run in the best interests of residents. EVIDENCE: The home is managed by Jo Hills who is an experienced nurse and manager. Ms Hill has a hands-on approach to her job.
St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 22 The manager said that the annual quality assurance survey was sent out in October 2006 but was unable to find the returned questionnaires at the inspection visit. A quality assurance report for 2006 has also not been compiled. The annual quality assurance report of 2005 was not completed and therefore not circulated to interested parties. The home is not handling any money belonging to residents. The manager confirmed that formal supervisions are now taking place regularly and some notes were seen on staff files to evidence this. The following steps are taken to ensure that the residents of St Bridgets nursing home live in a safe environment. • Fire records are in place showing that internal and external checks are being carried out at the required regularity of fire fighting equipment. Staff have fire training at the intervals deemed appropriate by the home. A fire risk assessment has been completed in respect of the home. This was last reviewed in March 2007. • Accident records are appropriately kept and regular analyses are undertaken describing how risk of such accidents occurring again are minimised. The home has a file containing data product sheets for the cleaning products etc in use at the home. It is again suggested that this is reviewed to ensure that it is up to date with the products in use. No products are decanted into other containers at the home and those seen clearly stated what should be done if the products are used inappropriately e.g. if they are swallowed. • There is a rolling programme of staff training in moving and handling, fire safety, food hygiene, infection control and first aid. • Hazardous substances are appropriately stored and equipment and systems are regularly checked and maintained. Areas of concern in respect of health and safety are referred to elsewhere in the report. They include:• the dangers posed by the home not controlling the temperature of the water coming out of hand basins, • the lack of manual handling assessments, • the lack of bed rail assessments • the lack of assessment of pipe work • and uncovered / unguarded radiators identified as putting residents at risk. • St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 23 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 3 3 3 N/A 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 2 X X 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 3 X 3 St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 13 Requirement Care files must all include moving and handling assessments, which are regularly reviewed. (previous timescale of 01/07/06) Where bed rails are in use an assessment must be in place that has involved appropriate people. The reason for use must be clear and how the bed rails are to be used. The assessment must be regularly reviewed. (previous timescale of 01/07/06) Where possible residents or their representatives must be involved in the preparation of their care plan and in it’s regular review. 2. OP25 13 To prevent risks from scalding the temperature of water must be controlled, in hand basins that could be used by residents, to about 43 degrees centigrade. (previous timescale of 31/3/05)
DS0000020497.V336750.R01.S.doc Timescale for action 01/07/07 01/07/07 St Bridgets Version 5.2 Page 25 Written risk assessments of the risk of harm through contact with radiators and pipe work to individual residents must be made, acted upon where appropriate and reviewed regularly. (previous timescale of 31/3/05) Where radiators have been identified as posing a risk to residents they must be covered / guarded. Pipe work around the home must be assessed and any risks identified addressed in a timely fashion. 3. OP29 19 All documents relating to staff recruitment as listed in the regulations must be obtained prior to employment. A system for evaluating the quality of the services provided at the home must be established and maintained as outlined in the care home regulations and national minimum standards. 01/07/07 4. OP33 24 01/07/07 St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 26 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. 2. Refer to Standard OP7 OP9 Good Practice Recommendations Each care plan should include a section on medication. When medication administration records are altered a second competent person should check the changes that have been made and sign to confirm this. A programme of routine maintenance and renewal of the fabric and decoration of the building should be produced and implemented with records kept. Where a timescale has been set for compliance with any standard relating to the physical environment of the home, a plan and programme for achieving compliance should be produced and followed with records kept. 4. OP22 It is recommended that an assessment of the premises be undertaken by qualified persons, including an occupational therapist. It is recommended that 50 of care staff achieve NVQ level 2 in care (or equivalent). It is recommended that recruitment procedures are updated to be in line with the Care Home Regulations and the Home Office guidance for employers to prevent illegal working. All staff should be issued with terms and conditions of employment. 7. OP30 The home should be using the induction material produced by Skills for Care – the industry standard. 3. OP19 5. 6. OP28 OP29 St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 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
© 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 St Bridgets DS0000020497.V336750.R01.S.doc Version 5.2 Page 28 - 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!
