Care Home: Bakers Court Nursing Centre

What the care home does well Improvements noted have been identified in the above paragraph. What the care home could do better: We noted that although the service demonstrated that training was taking place this did not consistently impact upon the quality of care provided, an example being the two members of staff unaware of residents on their unit with pressure sores. Staff need to be more aware of protecting residents from environmental risks, particularly residents with dementia. The clinical accuracy within care plans could be improved upon. Random inspection report Care homes for older people Name: Address: Bakers Court Nursing Centre 138-140 Little Ilford Lane Manor Park London E12 5PJ two star good service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sarah Greaves Date: 0 6 0 7 2 0 1 0 Information about the care home Name of care home: Address: Bakers Court Nursing Centre 138-140 Little Ilford Lane Manor Park London E12 5PJ 02085143638 02085532603 stringch@bupa.com www.bupacarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) BUPA Care Homes Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 78 Number of places (if applicable): Under 65 Over 65 0 0 78 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 78 78 0 78 The maximum number of service users who can be accommodated is: 78 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (of following age range: 55 years and over) Dementia - Code DE (of following age range: 55 years and over) Mental disorder, excluding learning disability or dementia - Code MD (of following age range: 55 years Care Homes for Older People Page 2 of 9 and over) Physical disability - Code PD (of following age range: 55 years and over) Date of last inspection Brief description of the care home Bakers Court Nursing Centre is registered with the Commission for Social Care Inspection to provide care to for up to 78 people with general nursing needs, physical disability, dementia orand a mental health diagnosis. The centre is situated in the Manor Park area of Newham and is easy to access by public transport. There is ample parking available for visitors within the grounds of the Centre as well as on the surrounding roads. The premises are purpose built and all the bedrooms are single with en-suite facilities. They are equipped with the nurse-call system, television and telephone point. The ground, first and second floor are connected via 2 lifts and the staircases. Each floor is run as a separate unit. The ground floor caters for people with general nursing needs, physical disability and mild to moderate dementia. The first floor is for people with a mental health diagnosis including dementia, while the second floor unit provides continuing care. The premises are fully wheelchair accessible. The designated catering team provide three meals a day and also tray service for people who prefer to eat in their own bedrooms or are unable to leave their beds. 3 0 0 4 2 0 1 0 Care Homes for Older People Page 3 of 9 What we found: We read three care plans during the course of this inspection; one from each unit. The first care plan was for a resident with a pressure sore. It was noted that appropriate measures had been taken, such as contacting the tissue viability nurse, informing the family and taking a photograph of the wound. The Waterlow risk assessment had not been updated following the discovery of the pressure sore and the body mass index was incorrectly scored on the Waterlow. An obsolete care plan for the use of laxatives remained within the main care plan. The second care plan that we looked at was for a resident that lived on the unit for people with mental health needs and dementia. We had previously met and observed the resident and noted that the care plan did reflect some of our own observations (for example, that the individual happily initiates conversation and enjoys one-to-one discussions). The care plan also stated that this person experienced hallucinations but of a comforting nature. The service had benefitted from the input of a quality manager with a registered mental health background, with a remit to re-assess and re-write all of the care plans in a more individualised way that took into account mental health needs. We also met the new unit manager for this floor, who had previously worked at the care home and was also involved in the updating of the care plans. The new unit manager is a registered mental nurse and more registered mental nurses have now been recruited. The third care plan was for a person with complex health care needs on the ground floor. We found that the care plan was well written. A health care professional had visited that day and advised the use of a prescribed item; the service had ensured that this directive was promptly followed. At the time of our arrival we found that a group of residents were assisting the activities staff to decorate communal areas in preparation for the launch of the International Cruise Week event. Residents with physical disabilities and/or mobility restrictions were involved, as staff consulted with them regarding how to present the decorations. The cruise activity involved cuisine from around the world and applicable entertainment; for example, residents stated that they were looking forward to the Indian food followed by a display of Bollywood dancing that was taking place on the day after our first visit. We spoke to a resident that had maintained an active lifestyle since moving into the care home over five years ago, including regular visits to the local town centre to meet family and friends for refreshments. The resident also had their own hobby within the care home, which provided mental stimulation and opportunities to chat to people. This was encouraged by staff. We observed lunch being provided on the ground floor unit. It was noted at the previous inspection that the standard of hospitality needed to be improved upon. At this inspection visit we found that lunch was served relatively soon after residents were settled at the dining tables. The menu plan advertised a choice of two main dishes, either sausages with onions or a turkey casserole, accompanied by potatoes and two vegetables; we observed that both choices were readily available to the residents in accordance to the preferences they had expressed earlier in the day. Care Homes for Older People Page 4 of 9 We joined two residents at their table, who stated that the quality of the food was good and enjoyable. Other residents that we spoke to expressed similar views. The residents on the ground floor have primarily been admitted to the care home due to physical health problems and mobility issues, although there was evidence that some people experienced short-term memory loss. We observed that one person was reluctant to eat the meal that they had ordered. Staff offered alternatives including a specific choice (bread and jam) as this was a known favourite of the individual. Other residents received either verbal prompting and/or physical support, in accordance to their needs. We noted at the previous mealtime that there had been a television switched on in a lounge that was adjacent to the dining room; this was no longer the case during our observation. We spoke to the Support Manager who stated that the need for quiet and relaxing meal time environments was being actively addressed throughout the care home.It was noted at the last inspection that a changing room for staff had not been locked on the first floor; it contained some unlocked lockers with staff jackets and bags. We were concerned that this could present a risk to residents with dementia who might be able to access items such as personal supplies of prescribed medications. On the first day of this inspection we found that a changing room was unlocked and we detected another unlocked changing room a few days later on a return visit (although there were signs on each changing room stipulating the need for these facilities to be locked). We have been subsequently informed that keypads have been installed on each changing room door. We also came across a communal bathroom that appeared to be in the process of refurbishment as there were empty paint pots, planks of wood and broken parts of chairs being stored in it. The staff nurse on duty stated that she was aware that the bathroom was accesible to the residents but was unable to explain why she had not made arrangements for the room to be locked. A communal bathroom that needed to be locked due to not being fit for use (was also being used for storage) was pointed out at the last inspection. We noted that a specific bedroom that we highlighted at the last inspection as requiring re-decoration had now been identified with a date for this work to be conducted. We were informed that three communal areas had been painted and decorated, and new furniture had arrived to be distributed in the lounges. The service was taking steps to promote the use of the communal lounges opposite the nurses stations, as this would offer closer supervision for more vulnerable residents.We identified at the last inspection visit that staff needed training in how to meet the mental health needs of the residents. We viewed the training plan and noted that a range of clinical issues were being addressed via training, including approaches to working with older people with mental health care needs and dementia, and the prevention and treatment of presssure sores. We asked two care workers on one of the units whether any of the residents had a pressure sore and were informed that there were none. We then spoke to a staff nurse and discovered that there were two residents with pressure sores. Irrespective of whether staff are new to a unit, we were of the opinion that all staff should be briefed regarding Care Homes for Older People Page 5 of 9 whether a resident has a pressure sore as this would impact upon the care given during a shift. Depending on the individual needs of the resident, such care might well include promoting fluids and a nourishing, high protein diet, checking if dressings intact after toiletting, monitoring that pressure relieving equipment is working and assisting/encouraging a person with changing positions to relieve pressure areas). We noted that a pressure mattress was not working and pointed this out to a care worker, who responded by moving inappropriate dials. We were informed that the dementia care adviser for the service provider had visited the service in order to conduct an audit and make recommendations. There were no concerns noted with staffing levels and skill mix at the time of our visits.The new manager was not present at the time of this inspection, therefore we spoke to her at a later date. The manager was previously in post as the registered manager of a BUPA nursing home in Havering, rated as good by the Care Quality Commission. It is noted that the manager has considerable experience within general nursing and management, including a community nursing qualification. The most recent inspection report in 2009 for the managers previous care home identified positive management strengths. The manager stated that she would be undertaking a training programme that BUPA was introducing, which had been developed for registered general nurses that did not have a registered mental health nursing qualification. What the care home does well: 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 2. Care Homes for Older People Page 6 of 9 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 9 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, 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 8 of 9 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. 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