Inspection on 06/11/08 for The Bill House

This inspection was carried out on 6th November 2008.

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

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

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Bill House 98 Grafton Road Selsey West Sussex PO20 0JA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sheila Gawley     Date: 0 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: The Bill House 98 Grafton Road Selsey West Sussex PO20 0JA 01243602567 01243604746 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Eleanor Jean Morris Type of registration: Number of places registered: Alexander Park Homes Ltd care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 38. The registered person may provide the following categories of service only: Care home only - (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental Disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home 38 38 Over 65 0 0 Care Homes for Older People Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This site visit as part of the inspection process was carried out on 06/11/08. It was undertaken by a lead inspector from the Commission for Social Care inspection who was accompanied by an Expert By Experience. An Expert by Experience is a person who, because of their experience of using services, visits a service with an inspector to help give us a picture of what it is like to live in or use the service. Prior to the visit all files held by the commission, complaints and safeguarding issues were reviewed. The home had sent us their Annual Quality Assurance Assessment for the inspection, which gave us the information we needed on the home. We were not in receipt of any Care Homes for Older People Page 5 of 26 surveys but people who use the service, relatives and staff were spoken to on the day. One person who uses the service stated the staff are very good here. Another stated that the food is too tempting One relative stated that The home is much improved under the new providers and that the home has a happy atmosphere Staff spoken to on the day stated that they were happy working in the home. The hairdresser who was visiting the home was spoken to and she stated that residents look neat and clean at all times and are especially clean after meals. We also spoke to the local Community Nurse Manager who informed us of improvements in the home which are detailed in the relevant sections of the report Five people who use the service were case tracked during the inspection and all records relating to them were inspected. The premises were toured. The Providers and acting manager facilitated the inspection and any documents required on the day were made available. The atmosphere within the home was peaceful and relaxed and the staff carried out their duties in a respectful manner taking into account the dignity and privacy of residents. What the care home does well: There are new and comprehensive pre admission assessments in place. Care plans are in place to ensure all needs are recorded and met needs. Care needs are met with respect and dignity. The lifestyle and activities in the home meet the needs of people WHO use the service. Nutritious meals are served in a pleasant and unhurried manner. Complaints and protection issues are addressed. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality in this outcome area because needs are assessed and information needed to make an informed choice is available. This judgement has been made using available evidence including a visit to this service. Evidence: There are new and comprehensive preadmission assessments in place. Three of these were inspected and the assessment criteria were all completed, this included safety to self and others, mobility, primary care needs, dietary need, sleep, hygiene and personal care needs, dental and optical needs and living preferences. Care Homes for Older People Page 9 of 26 Evidence: A statement of purpose and service user guide was supplied to the Commission during the registration process and these supplied the information needed by a person wishing to use the service. All people who use the service have a contract and terms and conditions in place. Care Homes for Older People Page 10 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality outcomes in this area because all needs are assessed, set out in a plan and met, People who use the service are treated with respect. Medicines are handled safely according to policy. This judgement has been made using available evidence including a visit to this service. Evidence: All residents had a plan of care. Five people who use the service were case tracked,) their care plans were inspected and these contained information on health, personal, nursing and social need. I had a conversation with three of these people. All indicated satisfaction with the care in the home. The care plans are drawn up following an assessment of needs. This included mental, physical and social need, dietary needs, mobility, hygiene, continence, daytime Care Homes for Older People Page 11 of 26 Evidence: routines. Weight is monitored. The mental health assessment has information on orientation, sensory abilities, memory and orientation, cognitive functioning and challenging behavior. There are daily records and monthly review. Risk assessments are in place including self-medication,self harm or neglect, challenging behavior, wandering, falls. People access health services via the local general practitioner and the home has the support of the district nursing team as required. These interventions are recorded in the care plans. The local Community Nurse Manager was spoken to on the telephone and she confirmed that they are called in promtly to assess wounds, that communication is improved and that they have observed improvements in moving and handling with hoists correctly used. Care needs are met with respect and dignity, The expert by experience observed carers gently persuading people who use the service to move about as required and that also hoists are used as required. There are traing, policies and procedures in place to support the safe handling of medicines. Medicined were seen to be received, stored, administered and returned correctly. Medicine administration charts inspected were up to date. Care Homes for Older People Page 12 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality in this outcome area because the lifestyle experienced in the home meets the needs of people who use the service . This judgement has been made using available evidence including a visit to this service. Evidence: The main objective of the Expert by Experience was to look at how the staff maintain and promote residents dignity, independence and respect: in terms of the environment, residents appearance and laundry therefore she focosed her time in the home in the living and dining areas of the home. These are some of her comments on the lifestyle, activities and mealtimes in the home. During the morning I observed one of the male residents sitting on his own in the dining room. I sat down next to him and managed a partial conversation, he seemed content on his own with passing carers popping their head through the door and saying hello. Later he wandered into the lounge and sat in different chairs never really settling. One of the carers told me he could be aggressive at times and whilst Care Homes for Older People Page 13 of 26 Evidence: the carers were watchful for him they let him come and go as he wanted Two professional entertainers come in twice a week and one of the carers who works from 7am to 10am washing and dressing residents and helping with breakfast then works until midday as an activities worker. One of the other male carers is currently training to be a 2nd activity worker. The day I visited the activity worker and one of the male carers were entertaining in the large lounge. As we were leading up to Remembrance day, dance music was being played from the war years and for those residents who could get to their feet, sometimes it took both care workers, they were encouraged to have a dance. For those who couldn’t, one of carers would stand or kneel in front of them and hold hands and gently sway and sing to the music. Looking around the room everyone was smiling, some were moving their hands and arms to the music and evidently enjoying watching the activity going on in front of them. One or two of the women residents would get up and do a little dance on their own with the activity worker encouraging them. The activity worker told me when the weather is good she will take 2 or of the residents at a time round the garden or at the side of the garden down to the beech for a walk. She organises tea parties with music on the terrace which will have themes, for example the Charleston. Her comments on lunch time were, The chef, who joined the home in October 2008 plans the meals for 2 weeks at a time. There are currently no residents with particular dietary needs other than some residents need their food pureed. For breakfast there is a choice: porridge, cereal, prunes, kippers, bacon and eggs, sausages and toast. Lunch is a choice of 2 meals with seasonal vegetables. The day I visited there was chicken or meatballs with roasted pumpkin, carrots and peas with a hot desert or ice cream. Supper is on alternate days hot or cold and the chef bakes 5 days a week so there is always homemade cakes for tea. the chef, who served the meals himself so as he can see what each resident eats was told who each meal was for by the carer and the amount placed on the plate adjusted for that resident. Each resident also had a cold drink with their meal. Overall she felt that The activity observed brought real enjoyment and pleasure to the residents. There appeared to be a short period where residents were left unsupervised and although the group activity covered the majority of residents she felt that some residents needed some time for individual attention. I observed the carer feeding one of the residents, he maintained eye contact, wiped her mouth, gave her a drink, talked to her, checking she was ok, squeezed her hand. As he fed her, one of the other residents started shouting, he got up and stroked his face to reassure him and then continued to talk to him when he resumed feeding Care Homes for Older People Page 14 of 26 Evidence: Breakfast had been observed by the lead inspector and this too was quietly served and those requiring help were offered it in an unobtrusive and respectful manner, speaking all the time to the person, here is some egg now or Here is some sausage now. Relatives are welcome in the home. One relative spoken to stated that she is very happy with care in the home, I’m really happy with Dad here. I go home after visiting and I’m not worried about Dad he’s safe here and he’s happy She felt it had particularly improved since the new providers took over and also the appointment of a new manager. The expert by experience stated I was very impressed by the appearance of the residents. All the residents were groomed, the men had been shaved, all those who had false teeth had their teeth in, clothes were coloured coordinated. The local Community Nurse Manager was spoken to on the telephone and she confirmed that people who use the service now have improved appearance with the women having make up on. There is an all about me form in the care plans which can detail personal history and likes and dislikes. Social activity is recorded as is the responses to the individual activity. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service experience good quality outcomes in this area because a complaints system is in place and systems are in place to protect them from abuse. This judgement has been made using available evidence including a visit to this service Evidence: There is a clear complaints procedure which is on display and which is included in the Statement of Purpose and Service User Guide. The procedure clearly identifies whom a complaint should be addressed to and the timescales in which a complaint would be addressed. People who use the service and a relative spoken to were clear as to whom they can raise concerns with The relative stated there was little need to complain as the home is well run.There are safeguarding policies and procedures in place and staff had safeguarding training yesterday. There is a policy on managing challenging behaviour which further protects people who use the service. The providers have fully cooperated with two safeguarding investigations, one of which was ongoing when they purchased the home, the other they raised on finding irregularities on how the money of people who use the service was handled. They have made the neccessary referrals to the Protection of Vulnerable Adults list Care Homes for Older People Page 16 of 26 Evidence: . Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality in this outcome area because they live in a well-maintained homely and relaxed environment with pleasant grounds and garden areas. This judgement has been made using available evidence including a visit to this service. Evidence: The home is clean and well decorated throughout. The main part of the home has two sitting rooms and two dining rooms. The annex has a further sitting room, dining room and a conservatory. There is a smoking room sited away from all of the communal areas. Bedrooms are comfortable and personalised and all have en suit facilities. A new boiler system has been installed. There are suitable laundry facilities sited away from areas of food storage and preparation. The home meets the requirements of the local environmental health authority and are considering extending the kitchen on the advice of the last visit from the authority. All bedroom doors have locks and are kept locked once they have been vacated in the morning. There was discussion the new acting manager on this practice and she stated that she may , on discussion with the Care Homes for Older People Page 18 of 26 Evidence: providers review this practice. The expert by experience asked a relative what her opinion was of the practice on locking doors and was told ’ I don’t think it matters. If Dad wanted to go and lie down someone would take him. But he likes the company and if he wants to sleep he can doze in the armchair The expert by experience had the following comments on the environment The atmosphere is very light, warm and welcoming throughout, the home is very clean and pleasant smelling. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality in this outcome area because needs are met by suitably qualified staff. This judgement has been made using available evidence including a visit to this service. Evidence: Staff rota showed staffing levels were sufficient to meet the needs of residents. There is housekeeping, laundry and kitchen, gardening and maintenance support. The provider stated that they are recruiting 2 new carers and a kitchen assistant. There are robust recruitment procedures in place and staff files inspected contained all the documentation required to ensure the protection of people who use the service. There was evidence of application forms with employment history. Criminal Records Bureau Clearance and POVA check, two references, identity documentation, and photograph were all in place. Staff spoken to all stated that the home is a pleasant and supportive place to work. All stated that there have been great improvements since the new proprietors have taken Care Homes for Older People Page 20 of 26 Evidence: over. They confirmed that the new chefis very good People who use the service find the find the staff helpful. One person said Staff are very nice here, another they come when i call them There is a staff training programme in place which covers all mandatory training. Fifteen of the nineteen carers have attained National Vocational Qualification Level 2 or above. The acting manager is about to commence the LEADERSHIP qualification. The home operates a key worker system which staff demonstrated an understanding of. Staff were also aware of Whistle blowing procedures. Staff confirmed supervision is in place. The local Community Nurse Manager was spoken to on the telephone and she confirmed that staff communication with her team has improved and that improved moving and handling techniques have been observed. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality in this outcome area because the home is run in the best interests of the people who use the service. This judgement has been made using available evidence including a visit to this service. Evidence: The recently appointed acting manager has many years experience in care and is applying to the Commission to be registered. She has had some dementia training and is about to commence another course in this, she is also to commence a recognised management course. Staff, a relative and a district nurse manage spoken to stated the the home is well managed and that there has been an improvement in the management of the home under the new proprietors and the new acting manager. Quality assurance systems are being implemented. The home sent us the AQAA when Care Homes for Older People Page 22 of 26 Evidence: we requested it and it contained the information we needed. Staff meetings and supervision are in place. There are also residents and relatives meetings, the next relatives meeting is on November 16th. The home conducts an internal audit on falls. The proprietor stated that questionnaires are being planned and she hopes to get them out to relatives and professionals next month. Monies for people who use the service are held separately, securely and are expenditure is recorded and receipted. Amounts inspected were accurate. The providers are in receipt of a some of money from the previous providers bank account relating to two residents. They are seeking advocacy to establish the correct amount due in fees and the amounts that are the peoples allowances as a breakdown was not supplied with the transaction. The need to handle the money of people who use the service according to best practice was discussed, including not banking peoples money in the homes bank account was discussed with the proprietor. It is suggested that they refer to the section on the CSCI website-In Safe Keeping, Supporting people who use care services with their finances The registered providers ensures the health, safety and welfare of people who use the service by the provision of mandatory training. The home meets the requirements of the local Fire Authority and Environmental Health Department. Substances hazardous to health are stored securely. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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!