Care Home: Bamfield Lodge Care Home

What the care home does well Vast improvements have been made with the quality of this service and this is relected in how people are cared for and how the home is being run and managed. The staff team should be commended for providing people with an excellent quality service. The admission of new people in to this home is well managed and people who choose to live here, and their families are given detailed information about what the home has to offer. This means that they will know what to expect from Bamfield Lodge. People who live here will be well looked after, and their individual care needs will be met in the way that they want. Care staff will respect their dignity and ensure their privacy is maintained. This is because care planning processes are person centred. Medication procedures are well managed and are safe. People are able to spend their time as they wish but will be provided with the opportunity to participate in a wide range of different activities. They are able to maintain contact with family and friends, and to continue with any activities outside of the home if they can. They are provided with a well balanced and nutritious diet, and the meals are well cooked and nicely presented. The people who live here can be assured that any complaints or concerns they may have will be listened to and acted upon. They will be cared for by staff who will safeguard and protect them from coming to any harm. Bamfield Lodge is a very comfortable and well furnished home. It is equipped to meet the needs of the people who live there, is clean tidy and fresh smelling. The people who live in Bamfield Lodge will be cared for by staff who are skilled and competent to do their jobs. They are well trained and this means that people can be assured that their needs will be met. The people who live in this home will find it is well managed and run in their best interests. It is safe and their welfare will be protected. What has improved since the last inspection? Six requirements were issued as a result of the last inspection and each has been fully complied with. 1 and 2) Care planning processes have been improved and now include details about people`s preferences. The reviewing process includes the views of the individual and their relatives/representative. 3 and 4) Medication systems have been improved. Where people are prescribed `as required or PRN medicines`, instructions are provided for staff on how often these can be administered and for what reason. The recording, handling and storage of all medication is in line with good practice. 5) Staff are being formally supervised and their training and development needs are being identified and met. 6) All necessary checks of the fire alarm system are being completed at the rate recommended by the Fire Officer. What the care home could do better: It has not been necessary to issue any requirements as a result of this inspection. One good practice recommendation has been made. The home should obtain official oxygen warning signage to display where oxygen is in use or is being stored. Key inspection report Care homes for older people Name: Address: Bamfield Lodge Care Home 1 Bamfield Whitchurch Bristol BS14 0AU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Vanessa Carter     Date: 1 1 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Bamfield Lodge Care Home 1 Bamfield Whitchurch Bristol BS14 0AU 01275891271 01275839643 bamfieldlodge@averyhealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Avery Homes Bristol Ltd care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 60. The registerd person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability aged 45 years and over on admission (Code PD) - maximum of 16 places Dementia aged 45 years and over on admission (Code DE) - maximum of 16 places - personal care only Date of last inspection Brief description of the care home Bamfield Lodge was purpose built in 2007 to provide nursing and residential care for up to sixty people that are over 45 years old, have physical disabilities, dementia and terminal illness. The property has level access and is arranged over three floors with shared space and Care Homes for Older People Page 4 of 29 28 0 16 Over 65 0 60 0 Brief description of the care home bedrooms on each floor. The property is decorated to an excellent standard; all rooms are single and en-suite. The aims and objectives of the home is to foster an atmosphere of care and support which both enables and encourages people living at the home to lead full, interesting and independent a lifestyle as possible. Care Homes for Older People Page 5 of 29 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: three star excellent 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: The last inspection of this service was in July 2008 and our overall judgement of the service at that time, was that people who lived in Bamfield Lodge received an adequate service. After that inspection we had planned to visit again within one year, unless we had reasons to believe that the service was deteriorating and/or people were not safe. This inspection has been completed within the year. Prior to this inspection we sent out survey forms to people who live in the home and we had 14 forms returned to us. Unfortunately, we asked the service to complete their annual quality assurance assessment (AQAA) to late, and therefore we could not use the AQAA to plan our inspection. For this inspection we made an unannounced visit to the home and spent two days there. We looked at records kept by the home, including care records and those that are kept in respect of the running of the home. We spoke to those staff on duty, the Care Homes for Older People Page 6 of 29 acting home manager and the operations director. We spoke to 15 people who live in the home and a number of visitors, and we observed how the staff interacted with the people they were looking after. We looked around the home and the facilities available. We asked people what it was like to live in the home and we asked staff what it was like to work there. At the time of this report the fees for placement at Bamfield Lodge range between 525 and 702 pounds per week and are based upon assessed needs. These figures are for nursing care and those requiring just personal care will pay less. Additional charges will be made for other services and these are detailed in information made available about the home. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? Six requirements were issued as a result of the last inspection and each has been fully complied with. 1 and 2) Care planning processes have been improved and now include details about peoples preferences. The reviewing process includes the views of the individual and their relatives/representative. 3 and 4) Medication systems have been improved. Where people are prescribed as required or PRN medicines, instructions are provided for staff on how often these can be administered and for what reason. The recording, handling and storage of all medication is in line with good practice. 5) Staff are being formally supervised and their training and development needs are being identified and met. 6) All necessary checks of the fire alarm system are being completed at the rate recommended by the Fire Officer. Care Homes for Older People Page 8 of 29 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 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 10 of 29 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. The admission of new people in to this home is well managed and people who choose to live here, and their families are given detailed information about what the home has to offer. This means that they will know what to expect from Bamfield Lodge. Evidence: The statement of purpose and service users guide (welcome pack) is up to date and reflective of the service and facilities available at Bamfield Lodge. Copies of both documents are displayed in the main entrance to the home and copies of the welcome pack are given out to people who enquire about the home, and who live in the home. We saw welcome packs in some bedrooms when we went around the home. Both documents meet the guidance set out in the national minimum standards and contain all the necessary information to enable people to make a choice about living at Bamfield Lodge. The 12 people who completed our survey forms said that they had been provided with enough information about the home before they had moved in. One relative who was spoken with during the inspection said that had been impressed Care Homes for Older People Page 11 of 29 Evidence: with the information made available about the home and that it has all lived up to my expectations. Every person who stays in this home will be provided with a statement of terms and conditions. This specifies the room to be occupied and the fees payable. It provides details about primary care trust (PCT) contributions (towards nursing fees), local authority and service user contribution. The contracts for the four people who were case tracked as part of this inspection were seen. Of the 12 people who had completed our survey forms, 11 said they had received a contract No person will be admitted to the home without having first having been assessed to see whether the home can meet their specific care needs. An assessment visit will be made by one of the Bamfield nurses to either the persons own home or the hospital ward. Where appropriate additonal information will be gathered from health and social care personnel, so that as much information as possible is gained about the persons needs. A pre-admission assessment will be recorded and a draft person centred care plan will be formulated. We saw two such assessments that had recentlty been completed - the document is comprehensive and covers the full range of care needs. The home provides placement for up to 60 people with residential, nursing or dementia care needs. There is a 12 bedded dementia care unit for people who do not require nursing care, on the middle floor. Two of the available beds are funded by the PCT and are used for planned respite stays. We were told that some people will come and stay in the home for short stays, on a regular basis. Care Homes for Older People Page 12 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live here will be well looked after, and their individual care needs will be met in the way that they want. Care staff will respect their dignity and ensure their privacy is maintained. This is because care planning processes are person centred. Medication procedures are well managed and are safe. Evidence: A plan of care is prepared for each person upon admission to the home and this sets out the specific care needs of the person. The plans are based upon the intial information gained during the admission assessment process. The persons individual needs are recorded along with instructions for the staff in how these identified needs were to be met. We looked at the plans (My Life My Choices documentation) that had been prepared for four randomly selected people and they all evidenced that the plans had been drawn up in conjunction with the person. They included details about What is important to me and why, My expressed wishes, How you can best help to support me and, What interests me.These measures clearly place the person involved at the centre of the care planning process. People who were spoken with during the course of the inspection confirmed that they are looked after in the way that they want - I am Care Homes for Older People Page 13 of 29 Evidence: always asked if I am happy with the help I receive and I can not fault how I am looked after. In addition to the care plans a number of screening and risk assessments are undertaken in respect of manual handling procedures, the likelihood of developing pressure sores and nutritional needs. The care plans are reviewed on a monthly basis and are amended as and when required. One specific plan where the needs had recently significantly altered had not been updated although there was a record of the change in the persons needs. This was addressed during the course of the inspection. A daily record is kept for each person and it was possible to evidence that peoples care and support needs were being met, as per their care plans. The records that were looked at were written in a respectful manner and good accounts were made of any significant events that had happened. A log is maintained when GPs are consulted with or visit the home, plus a separate record is kept when other healthcare professionals are involved in the ongoing care of the person. Examples of other professionals who visit the home include District Nursing Services, chiropodists, hospice nurses, tissue viability nurses, physiotherapists, opticians and dentists. We saw that people will be registered with the local GP soon after admission, if they had not previously lived in the Whitchurch area. We were told that most of the people who live at Bamfield Lodge are registered with one practice and they visit every Monday and complete a ward round, as well as when necessary to see individual people. Those people whom completed our survey forms said that they always received the medical support that they needed. We looked at how the home manages the care of peoples wounds. We saw care plans that had been prepared detailing how often dressings were to be attended to and what products were to be used to assist in the healing process. A photograph will be taken of the wound on a regular basis to check on progress. We saw that appropriate pressure sore prevention equipment is being used where this is needed. The home has well managed systems in place for the ordering, receipt, storage and disposal of medications. The majority of medications are supplied in blister packs. Where medications are prescribed as required or PRN, there are instructions for staff to follow regarding how often they can be administered and for what reason. There are separate storage facilities in each unit and one of the registered nurses on each unit has delegated responsibility for the ordering of the monthly supplies. Where medicines are supplied in either bottles or packets, the date of opening is recorded. This ensures that medicines are not used when they are past their best-by date. Where oxygen cylinders are stored and in use, we saw that signage was in place, however it would be good practice if this was official signage that warned of the hazards that must be avoided. Care Homes for Older People Page 14 of 29 Evidence: People spoken with during the inspection confirmed that they were well looked after and that they get the support that they need. Observations of the interaction between staff and the people in residence evidenced that they are well thought of and treated with respect. It is evident that the staff genuinely care for the people they are looking. The staff are always so pleasant and polite and they always make sure I am happy with things were two comments received during the inspection. One person wrote in our survey form the carers are aware of my needs and are considerate of my feelings. The home will continue to look after people when they are in the terminal stages of their illness and are dying, and some of the staff have received training in palliative care. One staff member spoke of the importance in ensuring people had a good death and that relatives and other visitors were also supported in the process. The home has good links with the local hospice and hospice care nurses, and registered nurse have the appropriate skills and competences to be able to administer adequate pain control medications to those who need them. The home is well equipped to provide approrpriate equipment to aid peoples comfort, when they are confined to bed. Care Homes for Older People Page 15 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to spend their time as they wish but will be provided with the opportunity to participate in a wide range of different activities. They are able to maintain contact with family and friends, and to continue with any activities outside of the home if they can. They are provided with a well balanced and nutritious diet, and the meals are well cooked and nicely presented. Evidence: Bamfield Lodge Care Home employs two dedicated activity organisers, each having different qualities and skills. Between them they arrange a wide array of activities through out the week. A plan of the months activities is displayed on noticeboards in several places throughout the home, and there is a music event each week. For the month of June, entertainers had visited as well as musicians. Every one who was spoken with during the course of the inspection said that the entertainment was good - A guitar player is coming again this week - he is really good, the exercise classes are real fun and we have a laugh and I used to be so lonely before I came to live here. Now I am having a good life were some of the comments received. During the two day inspection we saw skittles being played in the lounge, a balloon exercise game, and a word game. We were told that the armchair exercise class is held four times a week, and that there is Sunday Service each week. One of the activities Care Homes for Older People Page 16 of 29 Evidence: organisers has just completed dementia awareness training and will be using information learnt to plan better activities for people in the dementia care unit. We were told that some people benefit better from 1:1 interaction, and others choose not to participate in any of the planned activities at all. We were shown the hanging baskets and the raised flower beds that have been made by some of the people who live in the home and one person told us It is my job to water the garden every day when it needs it. There are plans to start a number of evening sessions. People told us that they are regularly asked in the Residents meetings what they would like to do. There is a planned trip to Bristol Zoo in July and we were shown the photographs of when staff from the Zoo visited the home with a number of creatures. One person who lives in the home told us that they go out with other people from the home to a Singing for the Brain group. Comments on our survey forms included activities for the residents are excellent and my relative is settled and happy, enjoys the company, activities and the support. Birthdays will always be celebrated and people will be presented with a card and present from the staff and there will be a birthday cake served with afternoon tea. Parties will be arranged for significant birthdays if the person is in agreement. We discussed mealtime arrangements with the acting manager and the chef and were told that people are told what the next planned menu is and asked what they would like to eat. Those people who completed our survey forms(14), said that they always (7) or usually(7) liked the meals. There is a choice of two meals at each meal time but aternatives are prepared upon request. We joined a group of people for the midday meal on the first day of the inspection. There was a choice of roast pork, roast potatoes and vegetables, or a salad followed by rice pudding or banana and custard. The vegetables were fresh and well cooked. Some people had other meals, for example a mushroom omelette. The meals are always like this was one comment received during the meal time. We observed that the meals are served to people as if in a hotel, people are encouraged to help themselves and are provided with support where necessary. We were told that Sherry is offered to everybody on roast meat days. Meals are served in the dining room, lounge areas or peoples own rooms and each person can choose where they eat. Special diets including vegetarian, soft diets and caloried reduced diets will be catered for and where culturally specific dietary needs are required, these will be met. We spoke to people about the food that they are provided with and were told that the meals were good and varied. One person wrote in our survey form I like the fact that my daughter can have meals with me when she visits. Care Homes for Older People Page 17 of 29 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. The people who live here can be assured that any complaints or concerns they may have will be listened to and acted upon. They will be cared for by staff who will safeguard and protect them from coming to any harm. Evidence: The homes complaints procedure is included in the Statement of Purpose and is displayed in the entrance to the home.Those people spoken with during the course of the inspection said they knew how to raise concerns or complaints and would ask to speak to the home manager or one of the qualified nurses. In the last 12 months the home manager has dealt with a number of complaints. We looked at the records that are kept as a result of each of the complaints and were able to see the measures that were taken in dealing with the issues raised and the actions taken to bring about a resolution. The Commission has been contacted on six occasions by other parties who had concerns about some aspects of the service provided. Four of the complaints we asked the service to investigate the issues raised and to resolve. We were satisfied in each case that the complaint was handled appropriately. Relatives who we spoke with said the home manager and staff team were very approachable and always ready to listen. People who we spoke with said there is nothing to moan about here, everyone is so helpful and things have improved greatly and everything is fine now. Two of the complaints were dealt with following safeguarding protocols and the service cooperated with the strategy planning process. There is evidence to demonstrate that the service always acts in the best interests of the people who live there and take the Care Homes for Older People Page 18 of 29 Evidence: appropriate measures to safeguard people from any harm. All new staff recruits will receive Safeguarding of Vulnerable Adults (SOVA) training as part of their induction training programme. Further training is provided for the staff team as part of the National Vocational Qualification (NVQ) training programme and specific abuse training sessions. A number of staff have just attended a SOVA training session that was held in the home - there is a rolling training programme and all staff will attend this. Staff who were spoken with during the course of the inspection demonstrated a good awareness of abuse issues and of their responsibilities to report bad practice and safeguard the people who they are looking after. Staff spoke about the homes whistleblowing policy and this is referred to in team meetings and individual supervision sessions. Care Homes for Older People Page 19 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Bamfield Lodge is a very comfortable and well furnished home. It is equipped to meet the needs of the people who live there, is clean tidy and fresh smelling. Evidence: Bamfield Lodge is a purpose built nursing home, built in 2007. The accommodation is arranged over three floors and there is a passenger lift between all floors. The home is built on a corner plot, is surrounded by well planted gardens to the front and railings, with plenty of space for parking to the front and one side of the building. To the rear of the home there are secluded gardens with raised flower beds and hanging baskets (planted by some of the people who live there), and seating areas for people who want to sit outside. We were told that new thatched style umbrellas are soon to be installed in this area so that there will be more shaded spaces for people to sit outside in sunny weather. There is level access in to the main entrance where information about the home is dislpayed - the last inspection report, service users guide and complaints procedure. The doors into this area are automatic opening but there is a key coded security system to exit. The reception area is staffed between the hours of 8-2pm and 5-8pm and visitors are welcomed in to the home. The reception area is large and has an electric piano that plays music - this is a corporate feature of all Avery Healthcare care homes. Throughout the main parts of the home, the decorations are blue and cream, the corporate colours of Avery Healthcare. The first impressions of the home are that of a luxurious hotel. Care Homes for Older People Page 20 of 29 Evidence: There is one large lounge leading through to the main dining room on the ground floor. On the first and second floors there are also lounge/dining rooms with small kitchenette areas where people and or their visitors can make themselves hot drinks. The 12 bedded dementia care unit on the first foor is accessed via key coded doors and also has a lounge and dining room area in the centre. All bedrooms have ensuite facilities of a toilet and wash handbasin plus there are additional toilets located throughout the home. There are specialist bathrooms with various types of assited bathing equipment, on all three floors. Each of the bathrooms have been nicely decorated. There is a plentiful supply of specialist equipment in the home to meet the needs of people who have a physical disability, have reduced mobility or are older and frail. There are hoists and stand aids plus other items to assist in moving and transferring people. The corridors are wide and everywhere is wheelchair accessible. The majority of beds are specialist profiling beds but those people who are funded on a personal care only basis have normal divan beds. Bedrooms are all single and have ensuite facilties. They are comfortably furnished and have matching bedding and soft furnishings. People are encouraged to bring in personal items and small furniture to make their rooms their own. It is important for me to have all my family photos with me was one comment received during the inspection. Intelligent lighting is installed throughout the home and lights come on when movement is detected and go off when no movement is detected. The home is centrally heated and all radiators are guarded to safeguard people from harm. The home is well lit and emergency lighting is installed throughout the home A tour of the home was made during the inspection. Everywhere was spotlessly clean and tidy and fresh smelling. One visitors told us that when they were looking for a home for their parent, the appearance and cleanliness had been major factors in choosing the home. The 12 people who returned our survey forms said that the home was always fresh and clean. People spoken with during the inspection said their bedrooms were cleaned every day. Care Homes for Older People Page 21 of 29 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. The people who live in Bamfield Lodge will be cared for by staff who are skilled and competent to do their jobs. They are well trained and this means that people can be assured that their needs will be met. Evidence: We were told that at the current time there are 58 people in residence at the home, of which 28 have personal care needs only, and 30 have nursing care needs. Two of the nursing beds are currently vacant. There were 12 staff on duty on day one of the inspection, and this number of staff was determined based upon the collective dependency needs of the people living at Bamfield Lodge. Staff spoken with during the inspection said that the staffing levels were appropriate, but there are times when they are very busy - these are at key times during the day. Several of the people spoken with during the inspection made the comment that at times, they have to wait for assistance but in general help is available when they need it. Survey results were that staff are usually available when they are needed - at times during the day there seems to be a lack of staff and I do not think the staffing levels are appropriate in the evenings. There are at least two qualified nurses on per shift day and night plus care staff. The home also employs housekeeping and laundry staff, maintenance and gardening, catering and administrative staff, to meet peoples collective daily living needs. A sickness management strategy has been put in place leading to a reduction in last minute staff sickness and therefore use of agency nurses Care Homes for Older People Page 22 of 29 Evidence: and care assistants. Staff confirmed that they generally work on the same floor each shift and therefore get to know the people they are looking after well. This means that people will be looked after by staff who are familiar with their care needs and consistent care is provided. The carers are so kind and genuine and everybody is pleasant, the assistants are so kind and I have just been really poorly and can not praise the staff highly enough for the care I received. A positive caring attitude. Since the last inspection there has been an increase in the number of care staff who have achieved at least an National Vocational Qualification (NVQ) in Care at Level 2. Twelve staff have NVQ level 2 in Care, two have NVQ level 3 in Care and two have NVQ Level 3 in Promoting Independence. Other staff spoken with said they had just been signed up to start working on the award. In addition housekeeping staff and administrative staff have obtained NVQ qualifications. All new recruits to the staff team are expected to undertake NVQ training after they have finished their induction and foundation training. There are robust recruitment procedures in place to ensure that the right staff are employed to work in the home. New staff will have had to complete an application form and attend for interview with the person in charge. Two satisfactory written references, POVAfirst clearance and CRB checks will be obtained for all new recruits. We examined the recruitment files of four new staff members and they confirmed these arrangements. We also spoke to members of staff who had recently joined the staff team, about the recruitment process. New staff will complete an induction training programme when their employment starts and this will then ensure that they are familiar with the homes policies and procedures and are competent in meeting peoples needs. One fairly new member of staff said that they had been supported by the staff team until they felt confident in the role. New staff will complete a two day induction led by Senior Care Assistants and this will include fire safety awareness, manual handling and safeguarding of adults training. Staff comments received during the inspection included training opportunities are good and there is always something planned and I have just completed some dementia awareness training. Examples of other training that the staff team have recently received include palliative care, challenging behaviour, training for trainers, food hygiene, sensory deprivation training, health and safety and infection control. From what we have been told by both the management team and the staff who work in the home, there is a real commitment to provide well trained staff. Care Homes for Older People Page 23 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home will find it is well managed and run in their best interests. It is safe and their welfare will be protected. Evidence: There is currently no registered home manager in post although Avery Healthcare are in the process of recruiting for the post. In the meantime, a senior manager has been seconded to the home in order to provide leadership and direction for the staff team. A deputy manager has also been appointed who has previous community and care home experience. It was evident from discussions with both people who live in the home and the staff team that significant changes have been made in the management of the home, with all staff taking responsibility for getting the standards of care and service raised. Staff who were spoken with during the course of the inspection said that the manager was approachable, that they felt able to make suggestions and could discuss any issues about peoples care or home activities. Care Homes for Older People Page 24 of 29 Evidence: The people who live in the home remain at the centre of all decision making. Resident Meetings are held on a regular basis - one person said we are asked about meals and what we would like to do in meetings. Staff meetings are also held on a regular basis. Regular monitoring visits (called reg 26 visits) are made unannounced to the home by an Avery Healthcare senior person and a quality audit is completed. In addition a number of audits are completed on a daily, weekly and monthly basis. The maintenance person completes a visual check of the environment each day. Resident Satisfaction Questionnaires are carried out on a three monthly basis and people are asked to comment about the admission process, the surroundings, hotel services, courtesy, daily routines, care, catering, activities, complaints and suggestions. These measures will ensure that the service continues to meet the needs of the people living in the home. The homes does not provide facilities to look after peoples personal monies however do have a system where billable extras are invoiced to people on a monthly basis. This system has been introduced since the last inspection, after consultation with people who live in the home and relatives, and is reported to be working well. This may be for items such as hairdressing, newspapers, toiletries or chiropody. Supervision of the staff team is undertaken on a daily basis with additional informal support and formal 1:1 meetings between a staff member and a senior on a regular basis. Staff will receive a full handover report at the start of their shift, and care staff will be supervised in their daily work by senior care staff and qualified nurses. Those staff spoken with during the inspection said that they had regular supervision with a senior and a yearly appraisal of their work performance and training needs. The homes records that were examined during the inspection were all promptly produced upon request, were well maintained and kept secure in either the managers office, the administrators office or the nurses stations. The home is well maintained throughout and no health and safety issues were identified as a result of this inspection. The fire log evidenced that all necessary weekly, monthly and quarterly checks had been completed. The most recent Fire Risk Assessment was prepared in April 2009. We were told that one fire door is to be replaced as a result of this assessment. Practice fire drills are held on a regular basis and formal fire safety training is attended by all staff. Those staff spoken with during the inspection confirmed that they had had fire safety training. The arrangements for safe working practice in respect of the moving and handling of people are good - a plan of care is devised that provides instructions for staff so that they know what equipment is required and how many of them must complete the task. These Care Homes for Older People Page 25 of 29 Evidence: measures will ensure that people are always moved safely and people will not be harmed by unsafe manual handling. We observed staff going about their duties and using manual handling equipment properly. Records evidenced that all the utility services (gas, electricity and water) had been serviced and checked and all the nursing equipment is serviced (Loler checks) on a six monthly interval. Portable electrical equipment was last tested in April 2009. All these measures evidence that the home takes their responsibility for the health and safety of the people who live and work there, seriously. Care Homes for Older People Page 26 of 29 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 27 of 29 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 1 9 Official oxygen warning signage should be obtained and displayed where oxygen is in use and is stored. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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