Inspection on 24/07/07 for The Bush

This inspection was carried out on 24th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Bush 04/03/09

The Bush 22/01/08

The Bush 19/01/07

The Bush 14/03/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The Bush 37 Bush Street Wednesbury West Midlands WS10 8LE Lead Inspector Andrew Spearing-Brown Key Unannounced Inspection 08:55 24 July and 3rd August 2007 th 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 The Bush DS0000064824.V340463.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. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Bush Address 37 Bush Street Wednesbury West Midlands WS10 8LE 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) 0121 526 5914 0121 526 5914 Rajan Odedra Usha Odedra vacant post Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may provide four places in the category of DE(E) for the existing four residents named in the application dated 12 July 2006 for the period of their residence in the home. Once the placement has ended the numbers revert to the original registration category of OP. 19th January 2007 Date of last inspection Brief Description of the Service: The Bush is registered to provide personal care for 44 people over the age of 65 years and is jointly owned by Mr Rajan Odedra and Mrs Usha Odedra, trading as ‘Bush Residential’. Currently the home does not have a registered manager in post. The property is a large, extended, detached building, once used as a Public House, from which the Home takes its name. Situated within walking distance of Darlaston Town Centre it is within easy reach of public transport and local amenities. The accommodation comprises of 30 single and 7 double occupancy bedrooms over two storeys, with a shaft lift to facilitate access between floors. There are no en-suite facilities. Communal facilities include a large lounge, a large dining area, a small lounge, a small dining room and a conservatory. A garden area at the rear of the property is accessible to people using the service. A car parking area is available at the front of the building. The acting manager stated that fees charged at The Bush are £337.29 per week. Additional charges are made for services such as hairdressing, toiletries, magazines and dry cleaning. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One regulation inspector based at the Worcester office of the Commission for Social Care Inspection (CSCI) undertook this unannounced key inspection. This inspection was conducted over a period of two days within the home starting at just before 9.00 a.m on the first day and 7.45 a.m on the second day, a total of 13 hours. The Bush is registered to accommodate up to fortyfour people. At the time of this inspection twenty-eight people were residing within the home. This inspection takes into account information received by the CSCI in relation to the home since the previous inspection as well as the visits to the home. Since the last key inspection, which took place during January 2007, the commission have received some concerns regarding the service provided at The Bush. A referral was made to Walsall Metropolitan Borough Council’s adult protection unit coordinator following some allegations made to the CSCI. Following a strategy meeting a number of recommendations were made and the case was then closed. Other concerns raised with the CSCI from different sources are included within this report. Since the last inspection The Bush has suffered a serious fire which totally gutted one bedroom and resulted in all the people living within the home having to temporally move to alternative accommodation. Prior to this inspection a Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with the CSCI areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to the commission within a given timescale. The acting manager completed this document and returned it the commission. Comments from the AQAA are included within this inspection report. Following the first visit to the home a number of questionnaires were sent to a sample number of people using the service, their relatives as well as health and social care professionals. A number of completed questionnaires were returned to the commission before this report was compiled and the contents of the completed questionnaires are taken into account as part of this inspection. A member of staff completed, on behalf of the individual concerned, four out of the seven questionnaires returned from people using the service. The remaining questionnaires returned were either completed by the person using the service himself or herself or by a representative. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 6 The acting manager was present throughout this inspection. One of the registered providers attended the home in order to take part in the final feedback session at the end of the inspection. Additional discussions took place with some members of staff, some community nursing staff as well as a number of people using the service. No visitors were seen during this inspection. A look around the home took place which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. What the service does well: Information was available for people who may move into the care home however this needs amending. The acting manager carries out an assessment of care needs before any new admission takes place to ensure that care needs can be met. Some training has taken place for staff regarding the care of people with a dementia type illness. Staff who have not received dementia care training are undertaking this in the near future. Visiting medical professionals who were consulted during this inspection voiced no concerns regarding the care provided to people using the service. As part of the consultation process some favourable comments were received including: ‘The staff care for me very well and always have since my arrival at The Bush’ Staff on duty during this inspection were seen to be respectful to people using the service. The atmosphere within the home was relaxed with people at ease with one another. Carers feeding people who needed assistance did so in a discreet and unhurried manner. The Bush operates a key worker (named worker system) to enable care staff to get to know a small number of people using the service better. During the visits to the home favourable comments were received regarding the food providing within the home. The percentage of staff currently qualified to NVQ (National Vocational Qualification) level 2 is good. Further staff are currently undertaking this training. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 7 An independent person visits the home on behalf of the registered providers and prepares a written report on a monthly basis. During this inspection people using the service spoke highly of the acting manager. What has improved since the last inspection? What they could do better: The information available to people prior to moving into the home and on admission needs to be amended. Some of the information included within the documents seen was incorrect and did not reflect the service provided at The Bush. The care documentation was in many incidents insufficient in detail as well as not filled in and updated as necessary. As a result the service cannot evidence that people using the service receive care in a consistent manner that meets care needs. Care plans were not person centred or individual and do not fully reflect peoples care needs. Medication management is in need of improvement. A number of concerns were highlighted regarding the recording, administering and storage of medication within the home. Comments regarding the availability of activities was mixed. Although some people felt that activities are arranged others did not. The recording of concerns and complaints within the home needs to be improved as does the recording of the action taken to resolve the matter. The local procedures regarding adult protection need to be available within the home. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 8 The home is in many areas poorly maintained and in urgent need of refurbishment. The lighting in communal areas was of concern especially following the comments made within a previous report. The Bush has not had a registered manager since October 2006. A manager must be appointed and an application to the commission for registration must be made. Quality Assurance systems need to be developed further in order that suitable systems to monitor the quality of the service provision are in place. A number of health and safety matters were evident throughout this inspection. Some matters were in relation to the environment such as some fire doors not fully closing while others were in relation to practice matters such as the lack of footrests on wheelchairs and the checking of bedrails. 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. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 9 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 The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 10 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): Standards 1, 2, 3 and 4. Standard 6 is not applicable to this service. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Prospective people who use the service and their representatives have information available to them to assist with choosing the home and seeing if their needs can be met. This information is freely available however some of it is incorrect and is not an accurate reflection of the service provided therefore removing its effectiveness. An assessment is carried out so that care needs can be agreed prior to an individual’s admission into the home to ensure that needs can be met. EVIDENCE: At the time of this inspection The Bush was accommodating twenty-eight people, this is a similar number to that noted as part of the previous The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 11 inspection. As the home is able to accommodate forty-four people a total of sixteen vacancies existed. It was noted while having a look around the home that a copy of the homes service users guide was located within each bedroom. People using the service had signed a sheet stating that they had received a copy of the service users guide. The availability of this information is good and is encouraged. The acting manager supplied the inspector with a copy of the service users guide and the homes statement of purpose. These documents were viewed following the visits to the home. Both documents are detailed and informative. The information includes a copy of the homes aims and objectives and ‘Service Users Charter.’ It seems likely however that the documents are taken from some prepared for another care home owned by the same providers as some information relates to another home and is not a reflection of the service offered at The Bush. Contracts or statements of terms and conditions were not assessed as part of this inspection. A blank copy of the ‘Service Users Contract ’ was included within the statement of purpose however it made reference to the former National Care Standards Commission rather than the Commission for Social Care Inspection and the range of fees differed from the information given by the acting manager. A file containing information regarding a recent respite (short stay) resident was viewed as part of this inspection. The file contained an assessment completed by a social worker from the purchasing local authority. It was evident that the acting manager had carried out a pre admission assessment. The information included within the two assessments differed however the acting manager was able to account for this conflict. The information within the pre admission assessment was basic however it was sufficient to commence a more detailed care plan. Comments regarding the insufficient detail within care plans are included within the next section of this report. The Bush is registered to provide accommodation for a number of individuals with a dementia type illness. These people were residing within the home prior to an application for a variation in registration which was made during July 2006. Although the primary care need of other people using the service might not be dementia care other people do have some memory lose. The care of persons with a dementia illness is specialist and therefore staff need to receive suitable and regular training. The acting manager stated that the majority of carers have received dementia awareness training while others are due to receive this training during August 2007. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 12 Although The Bush provides care on a respite basis, when a vacancy exists, this service does not include intermediate care therefore standard 6 of the National Minimum Standards is not applicable. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 13 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): Standards 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. Although some positive comments were received the lack of suitable evidence and up to date and accurate documentation could potentially result in people using the service not having their care needs fully met. Medication systems are not sufficiently robust to ensure that people receive their medicines safely. EVIDENCE: Individual care plans are in place for all people using the service. A representative sample of care plans were viewed and assessed as part of this inspection. Each of the folders seen were well laid out. A photograph was in place to help identification. The most recent daily records were held collectively in a separate folder. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 14 A form was seen in each care plan designed for people using the service to sign saying whether or not they were in agreement to receive personal care from a member of staff of the opposite gender. Having such an document is good practice however not all the forms were signed. The information on the daily notes was generally good. It was informative and factual. At times there was no recognition regarding the need to follow up on concerns noted within the daily notes. Therefore it was not always possible to establish whether the concern still existed or not. Care plans were insufficient in detail and tended to give aims and objectives rather than any strategies to guide staff as to how to meet care needs. For example terms used included ‘ staff to assist ** with all aspects of personal hygiene.’ ‘ encourage ** to wash and dress.’ or under behavioural management and strategies ‘ staff try to talk to **.’ Care plans were not specific and were not person centred. Some information included in the daily notes or obtained from talking to staff was not included within any care plan. One individual requires a thickener to be added to all drinks however this information was not on any care plan or risk assessment. Ensuring that all persons working within the home have the necessary information at hand to meet care needs is vital. A form to record the monthly review of care was seen to be in place. On the files viewed these forms had been used since April 2007. The details on the forms was satisfactory however on reading the daily notes it was apparent that some information was not taken into account therefore removing the benefits previously noted. Pressure relieving equipment was in use. It was stated that the tissue viability nurse working for the local primary care trust had visited the home. A number of community nurses attended the home during the course of the inspection. The community nurses voiced no concerns regarding the care provided within the home. Information returned to the commission from a local health centre stated that the home is ‘well run’ and described the care given by carers as ‘100 ’. It was stated that the manager (acting) converses with the practice in a clear and concise manner. Bedrail risk assessments were in place and bedrails seen on beds had appropriate bumpers to prevent accidental entrapment. No systems are in place to ensure that bedrails are in good order and maintained. The weights of people using the service are now maintained. These records commenced a few weeks ago once the sit on scales were repaired. It was noted that one individual had lost weight however this information was not transferred to the care plan. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 15 Fluid intake / output charts and turning charts are available. These records were not always maintained as necessary and gave no indication to the total amount of fluid taken. The care plan did not indicate the required amount of fluid needed or when intervention would be necessary. A representative from the supplying pharmacy visited the home on 30th April 2007. Following the visit a written report was produced which did not show any areas for concern. As part of this inspection the administering and management of medication was assessed. A number of concerns were brought to the attention of the acting manager. The home uses two trolleys to store the MDS (Medication Dispensing System) cassettes. These trolleys were locked but were not secured to the wall. On the first day of this inspection a significant number of the MAR (Medication Administration Record) sheets were viewed. The majority were completed as necessary although a small number of gaps were noted where nobody had signed to indicate the administration of the medication or a code to show why it was omitted. A course of antibiotics recently completed contained the correct number of signatures. When a variable dose was prescribed the actual dose given was recorded. The audit of another drug did not balance as two tablets too many remained within the MDS cassettes. Handwritten amendments to the MAR sheets did not have a second signature to demonstrate that another member of staff had checked the original entry. A list and specimen sample of the signatures of staff authorised to dispense medication needs to be updated. On the day of the second visit the inspector was concerned to note medication left on the dining room table near to the individual whose medication it was. Although acknowledged that it is an individuals choice when to take medication a number of concerns remain. Firstly staff will have signed the MAR sheet stating medication taken when it was not. Secondly it is possible that medication is either stored up and taken incorrectly or thirdly that somebody else takes the medication. The current practice needs to be re- evaluated and risk assessed. The MAR sheet of one person was checked against the medication listed on the care plan and found to differ. The list in the care plan failed to given the dose prescribed. On reassessing some MAR sheets as part of the second visit to the home a significant number of gaps were seen where nobody had signed for medication given. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 16 At the time of this inspection nobody living at the home was prescribed any controlled medication. A suitable controlled drugs cabinet is available however this was freestanding in the conservatory. As controlled medication is often prescribed with little notice it is strongly recommended that the cabinet be fixed to a wall using the necessary rag bolts. A fridge is provided for the storage of medication needing such a facility. Having this piece of equipment located within the kitchen is not ideal. The fridge was found to be unlocked (this was also found during the last inspection carried out in January 2007). A sheet to record the temperature of the fridge was stuck to the fridge door. The last time staff had recorded a temperature reading was the 22nd June 2007. Medication due to be returned to the supplying pharmacy was found within an unlocked room. This medication consisted of in excess of 120 painkillers and a total of 5 other tablets. All medication must be held securely at all times while within the care home. A tub of cream was found in a bathroom with ‘heels’ written on the label. This could indicate the communal use of items such as creams and ointments. Communal use of items brings about the risk of cross infection. The acting manager stated that staff have received medication training. The AQAA however under ‘Our plans for improvement in the next 12 months’ stated ‘ To ensure staff have full medication training.’ This information is clearly conflicting however taking into account the findings of this inspection it is evident that staff either need to attended suitable training or receive retraining regarding the management and administering of medication as a matter of some urgency. People using the service looked suitably dressed taking into account gender issues and weather conditions. People sat within the lounges or having meals within the dining room seemed relaxed and at ease with staff members. The majority of people appeared clean and tidy although some people had clothing that was either marked or too large. One person’s glasses were dirty therefore needed cleaning. One relative stated on a questionnaire returned to the commission: ‘ The Bush home does very well indeed with regards to giving my ** dignity. This is done by the way she is treated, dressed and above all the staff try to give all the residents a sense of purpose in life.’ Another relative commented that: ‘Staff do their best and are willing but are often in a rush.’ The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 17 Throughout the inspection staff demonstrated that they respect peoples privacy and dignity. A community nurse stated that she believes that people using the service are treated with ‘ respect ’. However a list of people using the service showing details of the size of pad to be used was displayed in a communal toilet. Although this is in place to assist staff it did not afford privacy regarding continence. The preferred term of address of each person using the service was included within his or her care plan. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 18 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): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People using the service are able to maintain contact with family and friends. Some activities are provided within the home therefore providing limited stimulation and opportunities. People using the service spoke favourable about the food available within the home. EVIDENCE: No visitors were seen during either of the visits to the home. The acting manager stated that people tend to visit either during the evening or at the weekend. Reference to relatives visiting was included within the daily notes seen. The AQAA document completed by the acting manager states that the home encourages ‘ families to visit at leisure and visit in the privacy of their own The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 19 bedrooms if wished ’ and that ‘ staff ensure friends and families are invited to join in activities arranged by our home. ’ The Bush does not employ an activities coordinator therefore the majority of activities and social stimulation has to be provided by care staff as part of their daily duties. A group of people living in the home stated that nothing happens in the home due to the lack of staff. Concerns were highlighted about the inability to go out for a walk due to staffing numbers. One questionnaire returned to the commission stated that the home offers no stimulus for people using the service and that there are no facilities for people to do painting and handicrafts. Some people using the service stated that they had enjoyed visiting a nearby public house recently. Some documentary evidence was available showing that activities do take place although the records lacked detail such as who took part, how long the activity lasted and any evaluation of the event. Events listed included exercise, skittles, quoits, bagatelle and hairdressing. A number of questionnaires were returned to the commission. Somebody on behalf on the person using the service completed the majority of the surveys returned. One question asks: ‘ Are there activities arranged by the home that you can take part in?’ The results were as follows: Always Usually Sometimes Never 2 1 3 1 Information was included within each individuals file about their background as well as their family and interests. The Bush operates a key worker system to enable cares to get to know a smaller number of people living in the home and their family and friends better. A range of responses were received regarding whether the home keeps in touch with relatives. Some people commented that home always keeps in touch while other stated either usually or sometimes. It was reported that one person using the service uses ring and ride to go to church. A representative from a local Christian church visits the home once per month to carry out Holy Communion. On arriving for the first visit of this inspection a number of people were having a cooked breakfast while others were having cereals and toast. The inspector was invited to join a group of people living within the service for lunch. The The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 20 main choice was pork chop with potatoes and vegetables. A small number of people had selected an alternative which was fish cake with parsley source. The meals were plated up in the kitchen before serving. Meals were well presented and appetising. Throughout the inspection favourable comments were made regarding the food offered. The main meal on the second visit to the home was fish chips and mushy peas. The chips were purchased from a local chip shop. Following this inspection one person stated via a survey that some people are not happy about the quality and variety of the food. The cook stated that she individually liquidised each item separately for people requiring a pureed diet. A number of people needed some assistance with their meal. Carers carrying out this role did so discreetly and in an unhurried manner. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 21 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): Standards 16 and 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People using the service have a suitable complaints procedure available to them. Concerns, comments and complaints need to be suitably recorded along with the investigation and action taken to evidence that they are taken seriously. Local procedures and information needs to be available to staff to ensure that people living within the service are suitably protected and that staff have suitable knowledge and information available. EVIDENCE: The acting manager recorded upon the AQAA returned to the commission that The Bush had not received any complaints since the previous inspection. While in the home it was stated that the complaints log was empty therefore indicating that no complaints were recorded. The homes complaints procedure was displayed in the entrance hall near to the main office and the large dining room. A complaints procedure is included within both the statement of purpose and service users guide. During discussions with some people living within the home a number of comments were made which had previously been brought to the attention of The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 22 the acting manager and the registered provider however it was evident that these were not recorded as either a concern or a complaint. The report following the inspection conducted during January 2007 highlighted the need to record all concerns, complainants and complements. Evidence from this inspection indicates that this has not received any suitable action and that the recording of concerns and complaints as well as investigations and actions taken is not happening as necessary. One relative commented upon a questionnaire returned to the commission ‘ Never had any reason to raise concern about the care my ** receives. ’ The vast majority of questionnaires return from people using the service stated that people know how to make a complaint. One person replied ‘No comment.’ Since the last inspection the commission has received some comments regarding The Bush. These comments were taken into account during the visits to the service. Due to the nature of some of the concerns brought to the attention of the commission a referral was made to the coordinator of Walsall Metropolitan Borough Council’s adult protection unit. Following a strategy meeting a number of recommendations were made and the case was closed. The homes procedures regarding adult protection were not viewed as part of this inspection. The AQAA confirmed that such a procedure is in place. This procedure will be viewed as part of a forthcoming inspection. The acting manager was not aware of any procedures or documents prepared by Walsall Metropolitan Borough Council although she agreed to contact the local safeguarding coordinator to establish what is available. It was reported during this inspection that the majority of staff have received training in relation to safeguarding adults from abuse. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 23 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): Standards 19, 20, 22, 24 and 26 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The environment in which people live is poorly maintained in a number of areas and is in need of refurbishment. Some shortfalls in health and safety are of concern. EVIDENCE: Previous inspection reports have highlighted a range of shortfalls regarding the environment and the need for refurbishment or redecoration in many parts of the home. The AQAA compiled by the acting manager and received prior to this inspection stated under ‘ What we do well ’ that the home is ‘ well maintained ’ this statement is not supported following this inspection. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 24 The inspection report following the visit conducted during January 2007 concluded that ‘There has been no progress in making the proposed improvements to the home’. The report stated that there were plans to improve facilities in the near future and that confirmation upon work proceeding was expected within four to five weeks. The above work has not yet commenced and it is of concern that in the meantime people are residing in an environment which needs up grading. Since the last inspection The Bush has suffered a serious fire which has totally gutted one bedroom. Nobody was injured as a result of the fire but people living within the home did need to move out for a short period of time and some have needed to temporally occupy a different bedroom having returned to the home. In addition to the gutted bedroom some other areas of the home were damaged due to water used while the emergency services extinguished the fire. The small dining room is particularly damaged and in need of repair as soon as insurance claims are settled. At the time of this inspection the wallpaper was damaged and skirting boards were marked and dirty. The door handle was dirty and the radiator had tea or coffee stains down it Taking into account the fire recently suffered within The Bush it was of concern to discover that the fire door leading into the small lounge and the door into the back dining room did not close fully into their rebates. Two other fire doors were checked and found to close correctly. These shortfalls were brought to the immediate attention of the acting manager. The previous inspection report contained a requirement to carry out a deep clean of the carpet within the smaller dining room. It was reported that this clean has taken place however the carpet remains to be stained due to in trodden food. The carpet down a small corridor leading off the main lounge was heavily stained. The standard of the décor along the corridor was poor. Some of the dining room furniture is unsuitable to supporting older people who may have poor posture or at risk of falling from the chair due to the lack of armrests. The easy chairs in both the main lounge and a smaller front lounge are in good condition. The previous report stated ‘The inspector stayed in the home until early evening after dusk. The lighting throughout the home seemed quite dull and this gave particular concern in the lounges where a third of the light bulbs on the fittings needed replacing and residents were struggling to read books and newspapers.’ The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 25 Taking the above comments into account it was of some concern that bulbs needed replacing in communal areas including both lounges and the small dining room on the first day of this inspection. It was of further concern that a number of bulbs were either missing or not working on the day of the second visit. As these visits took place during the day time it was not possible to assess the lighting levels however the comments made by the previous inspector regarding people struggling to read are likely to remain. None of the lights in bedrooms were tested during this visit however comments within the last report are drawn to your attention. The light was not working in one upstairs toilet. Lighting throughout the home will be assessed as part of a forthcoming inspection. Having suitable lighting is important for the health and safety of everybody within the home. One questionnaire returned to the commission highlighted a number of concerns regarding the environment including matters upon lighting stating that rooms are ‘dark and dreary’ ‘dirty and drab’ and ‘doesn’t feel “safe” ..poor lighting’. The same questionnaire stated that the individual believes the home has deteriorated over the last two years and described the décor as very depressing. The acting manager assured the inspector that the emergency call system was in working order in all occupied bedrooms. The alarm was activated in one bedroom and found to be functional. Clutter reported within the last inspection was not so prevalent on this occasion. A commode chair situated on the first floor was reported to be waiting to be thrown out. Bedroom doors have locks fitted, a lock on one bedroom door needs to be removed as somebody could potentially be locked in the room with no means of escape. No en suite facilities are provided. Screening is provided in a double bedroom however this only covers the wash hand basin and therefore would not be suitable in the event of somebody requiring personal care while in bed. The majority of freestanding wardrobes are not secured to the wall to prevent accidental toppling over and therefore possible injury. It was reported that reference in previous report regarding the need to audit beds and replace where necessary was referring to one bed only and that this was replaced. Toilets throughout the home are basic and functional. The floor coverings are stained. A frame around one toilet seat was damaged and rusty. A shower room is currently not used however the carpet floor covering is unsuitable were this area to be used in the future. A number of persons working within the home confirmed that it is proposed to refurbish the kitchen as part of the future plans for The Bush. A number of The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 26 concerns do however exist in relation to the current kitchen area. An Environmental Health Officer (EHO) from Walsall Metropolitan Borough Council visited the home in June 2007 and noted a number of shortfalls and concerns. Although some of the issues within the report have received the necessary attention many have not. The kitchen units were described as in disrepair and in need of refurbishment as they cannot be cleaned effectively. During this inspection the microwave oven was dirty, this was also highlighted within the EHO report. Fly screens are not in place to prevent insects getting into the kitchen via open windows. Although it is acknowledged that the providers intend to improve the kitchen facilities as part of a planned extension the current arrangements are in need of attention in the meantime. The exterior of the home needs maintenance. A crack running down some of the brickwork briefly discussed with the provider. It was reported that the necessary work to rectify is in hand. Some windows needed cleaning and the front continues to contain litter. The garden to the rear of the home was satisfactory although in need of some attention. Previous reports have brought to the attention of the provider that improvements are needed to improve the laundry walls to make them readily cleanable. Improvements to the laundry facilities form part of the extension plans to the home. Two carers (one was on induction training) were seen within a communal area of the home wearing disposable gloves before entering a bedroom. The inspector does not know where these carers had been beforehand. The acting manager agreed to ensure that infection control procedures are reinforced with members of staff. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 27 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): Standards 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. Staffing levels are sufficient to meet personal care needs but need to be kept under review to ensure that identified care needs including social and emotional can be met. The ratio of qualified staff is above the minimum standard and the majority of staff have attended mandatory training. Having a trained workforce can assist in providing a service able to met care needs. Recruitment procedures are satisfactory in order to provide safeguards against potential harm. EVIDENCE: Staffing levels within The Bush remain the same as previously reported. The staff rota showed that 4 carers are on duty each morning and 3 carers in the afternoon. It was confirmed that on occasions the acting manager needs to work as part of the care team, this was found to be the case on the first day of the inspection. 2 carers cover the night shift. The rota showed that the above staffing levels are maintained. In order to maintain staffing levels some staff work extra shifts. Agency staff are not used. The majority of carers are female. At the time of this inspection the home had 2 male carers. The staff team has a limited mix of cultural backgrounds. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 28 One relative stated on a questionnaire returned to the commission under the question how do you think the home can improve ‘ possibly more staff ’. Another relative commented that staff are ‘rushed’ and ‘busy’ Other comments regarding staff included: ‘ Very nice ’ ‘The staff care for me very well and always have since my arrival at The Bush’ The registered providers must ensure that staff are employed in sufficient numbers to enable care needs to be met. Taking into account the dependency levels of people using the service, the need to improve management systems and comments regarding recreational activities the current staffing arrangements need to be evaluated. The acting manager stated that 10 out of 16 carers have achieved a level 2 NVQ (National Vocational Qualification). This figure is therefore in excess of the National Minimum Standard. In addition to the current qualified staff another 2 persons have almost completed their training and another carer is about to start NVQ training. Assuming the staff currently taking NVQ training are successful and no other changes take place The Bush will have a high percentage of qualified carers. This level of qualified staff will be commendable. The staff files of two recently appointed employees were viewed. The files showed that appropriate checks had been made prior to employment commencing. As one person had commenced duty following the arrival of a PoVA (Protection of Vulnerable Adult) first check and prior to a full CRB (Criminal Records Bureau) a risk assessment was carried out. Notes from the interview were on file this is good practice. In future the acting manager needs to ensure that a full employment history is obtained and that the application form is fully completed. The training records seen showed that the majority of staff completed fire awareness training during March 2007. In addition it was reported that staff have completed food hygiene training and first aid training. Training is needed in infection control as only four persons have attended this training. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 29 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): Standards 31, 33, 35, 36 and 38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Some improvements in systems and risk assessments have taken place regarding management and administration since the last inspection. Despite these improvements some of the practices witnessed during the inspection place people using the service at risk. EVIDENCE: The Bush has not had a registered manager since October 2006. Since that time the registered provider and the companies area manager have supported the deputy manager who has recently worked as acting manager. The AQAA The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 30 document states that the acting manager has completed her RMA (Registered Managers Award) and her NVQ. The registered provider must appoint a manager and an application must be made to the commission regarding registration. The requirement to complete this by 31st March 2007 was therefore not met. Throughout the inspection people living within the home spoke highly of the acting manager. One person using the service stated that the acting manager is ‘ really good.’ An independent person, on behalf of the registered providers, undertakes Regulation 26 visits. These visits are to assess the conduct of the home and prepare a written report. Reports following visits were seen as part of this inspection. Other quality assurance systems need to be developed in order to monitor and develop service provision. It was evident that the acting manager has introduced formal supervision since the last inspection. Documentary evidence was available to suggest that staff will receive supervision in line with the frequency needed to meet the National Minimum Standard. This standard will therefore be reassessed as part of a forthcoming inspection. The public liability certificate was displayed within the home. It was noted that the certificate was about to expire, the acting manager confirmed that it had been renewed. Some money is held in safekeeping on behalf of some people using the service. The records regarding a sample number of people’s money were seen and found to balance with the cash held. It is however strongly recommended that two signatures be in place to verify withdrawals. A number of concerns regarding health and safety are reported earlier within this report such as fire doors not closing fully into their rebates and the need for safe systems to ensure bedrails are in order. In addition to the earlier concerns are others as follows. Chains to restrict the opening of windows are in place. Restricts are needed to prevent accidental or deliberate falling to the floor from windows over ground floor levels. The suitability of these restrictors needs to be kept under continual review. Some concern was expressed regarding the suitability of the chains in place as it was found that some windows could be opened wider than 100 mm (4 inches) this level of opening is the recognised amount suggested by the Health and Safety Executive. It was of concern that one restrictor found to of come off during the first day of this inspection had not been repaired before the second visit. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 31 Following the recent fire a letter dated 12th June 2007 was sent to the registered providers from West Midlands fire service. The letter detailed a number of deficiencies some of which have been addressed while others remain outstanding. The registered provider stated that a discussion has taken place with the fire officer to discuss matters such as fire retardant curtains and bed linen. Details of the above discussion and the proposed action plan must be forwarded to the commission. The records regarding fire safety were satisfactory. A number of risk assessments including one on arson are in place. On both visits to the home staff were seen transporting people using the service in wheelchairs without footrests in place. It was of serious concern that after this pointed out during the first visit the practice was seen again during the second visit. This practice can be potentially hazardous. It was stated that footrests are removed due to the inability to get wheelchairs into the lift with them in place. Concerns regarding heath and safety matters regarding the kitchen are included earlier within this report. Records of fridge and freezer temperatures are maintained showing that these pieces of equipment are generally operating at a level safe for the storage of food. It was of some concern that an oxygen cylinder was within an unlocked room. No warning regarding compressed gas was on the door and the cylinder itself was not secured to prevent accidental toppling. Reports were in place showing that the lift was services during April 2007. Although safe to use it was unknown what was meant by a comment on the report regarding some broken liners. Training undertaken by staff working at The Bush was assessed as part of this inspection although some areas were satisfactory other areas had some shortfalls. The findings regarding training are highlighted elsewhere within this report. The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 32 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 2 2 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 1 X 3 X 2 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 X 1 The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 33 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 OP1 OP2 Regulation 5 Requirement Information provided to potential and actual people using the service must be an accurate reflection of the service provided. A full detailed, comprehensive and specific care plan must be in place in relation to each person using the service. Other documents to support the care plan must be in place. Care records must be accurate and up to date. Medication must be given as prescribed and recorded accurately including handwritten amendments. Medication must be stored securely at all times and procedures must be safe in order to safeguard the welfare of people using the service. Meaningful and purposeful activities must be available to people using the service taking into account the care needs of individuals. DS0000064824.V340463.R01.S.doc Timescale for action 30/09/07 2 OP7 15 30/09/07 3 OP9 13 (2) 03/08/07 4 OP12 16 (2) (n) 30/09/07 The Bush Version 5.2 Page 34 5 OP16 22 Any concerns or complaints made must be recorded along with the action taken to resolve the matter. The Responsible person must provide the CSCI with a refurbishment/redecoration plan, together with a programme for the commencement and completion of all necessary works. All areas of the home must be well maintained and kept suitable for purpose. The above requirement replaces a number of previously unmet requirements while also including matters identified as part of this inspection. 31/08/07 6 OP19 23.(2)(b)(d) 30/09/07 7 OP19 23 30/09/07 8 OP19 23 An action plan following the most 30/09/07 recent visit undertaken by a fire officer must be submitted to the commission. The registered person and the 31/08/07 registered manager must provide suitable lighting in all areas including the following: 1) the lounge areas 2) individual bedrooms 3) downstairs bathroom The above requirement replaces a previous unmet requirement. This requirement must be met in full. 9 OP20 23 10 OP26 23(2)(d) Suitable facilities must be available for the laundering of clothing including the ability to wash the walls and clean around DS0000064824.V340463.R01.S.doc 31/12/07 The Bush Version 5.2 Page 35 the equipment. The above requirement replaces a previously unmet requirement with timescales of August 2005 and 31st March 2006. A new timescale is given 11 OP27 18 Sufficient staff must be on duty at all times in order to meet all the identified care needs of people using the service. A registered manager must be appointed and an application for registration must be made to the commission for social care inspection. The above requirement is similar to a previous requirement. Previous timescale of 31/03/07 not met. A new revised timescale is given for compliance. 13 OP38 13 Systems must be in place to protect the health, safety and welfare of people using the service. 31/08/07 30/09/07 12 OP31 9 30/09/07 The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 36 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 OP9 OP10 Good Practice Recommendations It is strongly recommended that the controlled drugs cabinet be fixed to a wall using the necessary rag bolts. The dignity and privacy of people using the service should be taken into account regarding any notices or information on public display. Further quality assurance system should be developed in order to monitor the service provided. It is strongly recommended that two signatures are in place to evidence withdrawals of money held in safe keeping on behalf of people using the service. 3 4 OP33 OP35 The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Worcester Local Office The Coach House John Comyn Drive Perdiswell Park Droitwich Road WORCESTER WR3 7NW 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 The Bush DS0000064824.V340463.R01.S.doc Version 5.2 Page 38 - 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. 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