Care Home: Bamford Grange Care Home

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What the care home does well The management and staff team continued to show a commitment and understanding of how important it was that people and relatives were supported to express their concerns and to use the formal and informal complaints process where needed. Records of complaints received were being maintained that showed how the management and staff had responded to the concern and the outcome for the person involved. A number of meetings with people and with relatives had occurred that allowed people to hear about the latest plans for the home and to express their views and concerns. The management and staff continued to be aware of the need to protect vulnerable people and the procedures and practices were in place that meant staff and management were aware how to respond to incidents and allegations if they occur. The manager and several staff were asked specific questions about their role in protecting people and they showed a good understanding of what they should do. The management and staff team had continued to improve the way that people`s needs and support were identified and recorded. Samples of people`s care plans were seen that contained clear and descriptive information and were person centred, in that they focused on what was important for the person and not just for the service. Staff had used their training and skills to carry out specific dementia assessments and to develop individual plans to improve the quality of people`s day-to-day lives. The staff were more aware of the need to focus on what people needed and one member of staff stated that this approach, `had been discussed in care assistants meetings where staff had been positively encouraged and supported to focus on what people can do. We are not to refer to supporting residents as `singles or doubles` (a reference to how many people were required to support a resident physically). Also not to refer to residents as wanderers and instead to think about the person and what can they do.` Staff commented that the support they received from the management team had continued to be positive. One member of staff stated that `the manager gives practical support with all aspects of care e.g. care planning.` They also confirmed that they received regular supervision. Another member of staff stated that ` the manager was always around to support staff, always on the unit. There was plenty of support meetings and supervision. The manager regularly consults with staff on day-to-day routines and activities`. The vast majority of comments from people and relatives was very positive about the standards of care and support given by staff. One relative said in the survey that, `Overall, the staff have a very caring attitude and they treat the residents as their own family.` The views of people who returned surveys was also positive with comments such as, `I rely on the staff to remind me what to do. Without this support my life would rapidly deteriorate.` And, `Coming to live in Balmoral unit has given me a much improved life style. It would be impossible for me to live without the support of the staff.` What has improved since the last inspection? The previous key inspection had highlighted the serious concerns we had regarding the staffing levels and the impact this was having on the safety and wellbeing of people and staff. The Random Inspection in January 2008 Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 8identified that the staffing levels across the home had been increased and that the number of negative incidents involving people had reduced. A comment from a relative spoken to during the site visit highlighted the changes that this increase in staffing levels had made. `I like the atmosphere in the home, the home is clean and the staff are good and hard working. They have been understaffed, but I can see a definite improvement. This home is good because of the staff.` Through spending time at the home and observing how people were supported it was clear that the atmosphere of the individual units was much more relaxed and calming. There was a lot of banter and social interaction between people and staff and staff appeared to have more time to respond to people when they needed reassurance. An example of this was when a person became very distressed at lunchtime and staff responded immediately with comfort and reassurance. People are prescribed medication to keep them well and healthy. The management and staff team should follow a medication administration system that aims to make sure this happens. The previous inspection report highlighted concerns we had about the way that staff were recording the administering of medication. The Random inspection in January and this key inspection showed that the staff had had additional training, the management had assessed their competence to administer medication safely and new systems had been put in place to make sure that records were being maintained and that mistakes were minimised. The previous key inspection highlighted the need for the management team to ensure that there are clear lines of communication and shared understanding on the issues facing the home and the solutions to achieve the stated aims and objectives of the service. The management team had been strengthened and supported by senior managers who knew the home and shared with the management team the sense of direction that they wanted the home to follow in terms of quality. It has already been noted in the section above that staff feel supported by the management team. One member of staff said that communication had improved. ` We have meetings every day at 10am to discuss the improvement of care and other things concerning residents.` The previous key inspection report highlighted that the issue of low staffing levels and supporting people with very high levels of need and dependency had had a negative impact on the provision of any structured programme of meaningful social and leisure activities.With the increase in staffing levels and a person centred focus of the support staff provide there had been an improvement in the social and leisure activities and interaction that people experience. Comments from people include, `The activities include holidays in Blackpool and Wales, day trips out to Yorkshire and Cheshire as well as visits to local cinemas and theatres.` Another resident said that they, `enjoy the activities very much.` In addition to the increase in staffing levels across the home the management team have shown further commitment to developing the skills and knowledge of the staff team through a comprehensive training programme. Staff are using the specialist skills and knowledge gained through training and study to understand and respond to people`s high level of needs in relation to areas such as dementia care. Staff have been very positive in this area with comments such as, `every year we have a schedule when to attend to a certain training to update ourselves and to improve our skills. And `All training is open to all staff who are available and willing. We have some training that is mandatory to everyone whether they like it or not for health and safety purposes`. A member of staff who had recently started work at the home felt that she had a very good induction. She said the induction had been ongoing for 3 months covering all aspects of health and safety and good care practice. What the care home could do better: The home employ staff to work with vulnerable people and so need to make sure that they have gathered all the information and checks needed to show that staff are safe to work with people. Part of those checks is to gain two references, with one being from a current/previous employer, before a person can start work. From the staff files sampled there was some references and other information missing. The management must make sure that all the correct checks and document are in place prior to a member of staff starting work at the home. A number of recommendations were made as a result of the key inspection that are suggestions to the home of ways that may improve the service that people receive. They are only recommendations and do not have to be followed. They are listed at the end of this report. CARE HOMES FOR OLDER PEOPLE Bamford Grange Care Home 239 Adswood Road Cheadle Stockport Cheshire SK3 8PA Lead Inspector Steve O`Connor Unannounced Inspection 6th May 2008 12:07 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 Bamford Grange Care Home DS0000068318.V362895.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. Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bamford Grange Care Home Address 239 Adswood Road Cheadle Stockport Cheshire SK3 8PA 0161 477 8496 0161 477 8269 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) Four Seasons (Bamford) Limited Susan Maria Goldsmith Care Home 79 Category(ies) of Past or present drug dependence over 65 years registration, with number of age (61), Dementia (60), Mental disorder, of places excluding learning disability or dementia (19), Mental Disorder, excluding learning disability or dementia - over 65 years of age (15) Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 79 users to include: *up to 61 service users in the category of DE(E) (Dementia over 65 years of age) * up to 60 service users in the category of DE (Dementia under 65 years of age). * up to 15 service users in the category of MD (E) (Mental disorder excluding learning disability or dementia over 65 years of age). * up to 19 service users in the category of MD (Mental disorder excluding learning disability or dementia under 65 years of age). No more than 19 service users aged 35 and above with mental disorder, may be accommodated. No more than 60 service users aged 55 and above with dementia may be accommodated. 30th January 2008 2. 3. Date of last inspection Brief Description of the Service: Bamford Grange Nursing Home is a purpose built care home that provides 24hour nursing care and accommodation to 79 service users. It is owned and managed by Four Seasons (Bamford) Limited. The home is split into three separate units. Kensington Unit on the ground floor has 40 beds and provides care for people over 65 years of age suffering from dementia but who are of a lower physical dependency. The first floor has two units; the Windsor Unit which is a high dependency dementia care unit, and the Balmoral Unit which provides a care service to people with a functional mental health disorder and who are generally under the age of 60. Each unit has its own lounge/dining area. Bedrooms are spacious single rooms providing en-suite facilities. A choice of bathroom or shower is available on each floor. The furnishing, carpeting and decoration are of a satisfactory standard. The home has its own hairdressing room, an activity room and Snoezlen room. Smoking is not permitted in the building. Bamford Grange has car-parking facilities at the main entrance to the home and garden areas are available at the rear of the home. The home is situated in the Adswood area of Stockport and is close to Cheadle and Davenport. Local amenities such as shops, pubs and GP surgeries are close by. Bus services are available and a local train station is approximately a ten minute walk away. Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 5 The current weekly fees range from £495 to £720 dependent on the package of care required. Further details regarding fees are available from the deputy manager. Additional charges may also be made for hairdressing and other personal requirements. Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection report is based on information and evidence we (the commission) gathered since the agency last had a key inspection in December 2007. Additional information, which has been taken into account, included incidents notified to the commission by the agency and information provided by other agencies. Before visiting the home, we also asked the agency to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helped us to determine if the management of the home viewed the service they provide the same way that we see the service. Before the visit to the home people who use the service, their relatives and members of staff were sent surveys and were asked to comment on the agency. By the time of the visit 9 people had returned surveys, 8 staff and two relatives. During the inspection site visit time was spent talking to people who wished and were able to speak to us, to the manager and staff and a senior manager from the organisation. As many of the people that the home support experience forms of dementia it was not always possible or appropriate to try to gather their views. Instead the interactions between people and staff were observed including over the lunch-time period on the Windsor Unit. Documents and files relating to people and how the agency was run were also seen. The inspection was an opportunity to look at all the core standards of the National Minimum Standards (NMS) and was used to make a judgement on the quality of the service provided by the agency and to decide how much work we need to do with then in the future. What the service does well: The management and staff team continued to show a commitment and understanding of how important it was that people and relatives were supported to express their concerns and to use the formal and informal complaints process where needed. Records of complaints received were being maintained that showed how the management and staff had responded to the Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 7 concern and the outcome for the person involved. A number of meetings with people and with relatives had occurred that allowed people to hear about the latest plans for the home and to express their views and concerns. The management and staff continued to be aware of the need to protect vulnerable people and the procedures and practices were in place that meant staff and management were aware how to respond to incidents and allegations if they occur. The manager and several staff were asked specific questions about their role in protecting people and they showed a good understanding of what they should do. The management and staff team had continued to improve the way that people’s needs and support were identified and recorded. Samples of people’s care plans were seen that contained clear and descriptive information and were person centred, in that they focused on what was important for the person and not just for the service. Staff had used their training and skills to carry out specific dementia assessments and to develop individual plans to improve the quality of people’s day-to-day lives. The staff were more aware of the need to focus on what people needed and one member of staff stated that this approach, ‘had been discussed in care assistants meetings where staff had been positively encouraged and supported to focus on what people can do. We are not to refer to supporting residents as ‘singles or doubles’ (a reference to how many people were required to support a resident physically). Also not to refer to residents as wanderers and instead to think about the person and what can they do.’ Staff commented that the support they received from the management team had continued to be positive. One member of staff stated that ‘the manager gives practical support with all aspects of care e.g. care planning.’ They also confirmed that they received regular supervision. Another member of staff stated that ‘ the manager was always around to support staff, always on the unit. There was plenty of support meetings and supervision. The manager regularly consults with staff on day-to-day routines and activities’. The vast majority of comments from people and relatives was very positive about the standards of care and support given by staff. One relative said in the survey that, ‘Overall, the staff have a very caring attitude and they treat the residents as their own family.’ The views of people who returned surveys was also positive with comments such as, ‘I rely on the staff to remind me what to do. Without this support my life would rapidly deteriorate.’ And, ‘Coming to live in Balmoral unit has given me a much improved life style. It would be impossible for me to live without the support of the staff.’ What has improved since the last inspection? The previous key inspection had highlighted the serious concerns we had regarding the staffing levels and the impact this was having on the safety and wellbeing of people and staff. The Random Inspection in January 2008 Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 8 identified that the staffing levels across the home had been increased and that the number of negative incidents involving people had reduced. A comment from a relative spoken to during the site visit highlighted the changes that this increase in staffing levels had made. ‘I like the atmosphere in the home, the home is clean and the staff are good and hard working. They have been understaffed, but I can see a definite improvement. This home is good because of the staff.’ Through spending time at the home and observing how people were supported it was clear that the atmosphere of the individual units was much more relaxed and calming. There was a lot of banter and social interaction between people and staff and staff appeared to have more time to respond to people when they needed reassurance. An example of this was when a person became very distressed at lunchtime and staff responded immediately with comfort and reassurance. People are prescribed medication to keep them well and healthy. The management and staff team should follow a medication administration system that aims to make sure this happens. The previous inspection report highlighted concerns we had about the way that staff were recording the administering of medication. The Random inspection in January and this key inspection showed that the staff had had additional training, the management had assessed their competence to administer medication safely and new systems had been put in place to make sure that records were being maintained and that mistakes were minimised. The previous key inspection highlighted the need for the management team to ensure that there are clear lines of communication and shared understanding on the issues facing the home and the solutions to achieve the stated aims and objectives of the service. The management team had been strengthened and supported by senior managers who knew the home and shared with the management team the sense of direction that they wanted the home to follow in terms of quality. It has already been noted in the section above that staff feel supported by the management team. One member of staff said that communication had improved. ‘ We have meetings every day at 10am to discuss the improvement of care and other things concerning residents.’ The previous key inspection report highlighted that the issue of low staffing levels and supporting people with very high levels of need and dependency had had a negative impact on the provision of any structured programme of meaningful social and leisure activities. Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 9 With the increase in staffing levels and a person centred focus of the support staff provide there had been an improvement in the social and leisure activities and interaction that people experience. Comments from people include, ‘The activities include holidays in Blackpool and Wales, day trips out to Yorkshire and Cheshire as well as visits to local cinemas and theatres.’ Another resident said that they, ‘enjoy the activities very much.’ In addition to the increase in staffing levels across the home the management team have shown further commitment to developing the skills and knowledge of the staff team through a comprehensive training programme. Staff are using the specialist skills and knowledge gained through training and study to understand and respond to people’s high level of needs in relation to areas such as dementia care. Staff have been very positive in this area with comments such as, ‘every year we have a schedule when to attend to a certain training to update ourselves and to improve our skills. And ‘All training is open to all staff who are available and willing. We have some training that is mandatory to everyone whether they like it or not for health and safety purposes’. A member of staff who had recently started work at the home felt that she had a very good induction. She said the induction had been ongoing for 3 months covering all aspects of health and safety and good care practice. What they could do better: 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. Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 10 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 Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information about a person’s support needs was gained prior to them coming to stay at the home. EVIDENCE: The previous key inspection report highlighted that the home needed to improve the quality of the information it gathered about people’s needs prior to them coming to live at the home. Since the last Key Inspection one person had been admitted to the home onto the Balmoral mental health unit. Pre-admission assessment information was seen that came from the purchasing authority setting out the person’s personal, social, emotional and mental health needs. The unit manager also undertook an initial assessment of the person’s needs to add to the information gained from the purchasing organisation. Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 12 From this information the home were able to decide whether they could support the person and meet their needs. The action taken by the home met the requirement made at the previous inspection. As only one person had been admitted to the home since the last inspection report it is recommended that the management make sure that before anyone comes to stay at the home clear, detailed and person centred information about the person’s needs is gathered through the purchaser and/or their own assessment process to make sure that they have the service and staffing to meet people’s needs. Intermediate care was not provided by the home. Bamford Grange Care Home DS0000068318.V362895.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): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s care plans reflected their general, health and mental health support needs. The medication administration system was being managed so that people received the medication they needed. People were observed being treated with respect and dignity. EVIDENCE: The previous inspection report highlighted that a lot of work had been done in the care planning process. Information was much more focused on the person and what they needed, rather than problems to be solved. The care plans were more detailed and focused on how to support people in the way they wanted. Since the last inspection the home’s manager, unit managers and relevant key staff had done further work on reviewing and developing the care plans so that Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 14 they reflected, in much more personal detail, a person’s needs and the actual support that staff provided to meet those needs. Samples of people’s care plans were seen and examples found where a person’s needs around their emotional health had been described in detail and stated clearly how staff should work and react with this person. People’s support needs were being reviewed on a regular basis depending on the complexity of their support. Records were seen of the monthly review carried out by the home and of the more formal reviews undertaken by the purchasing authorities under the Care Management and Care Programme Approach. It is recommended that the involvement of people and their family/representative in the care planning and review process be clearly recorded to show how people have been consulted and involved. People’s health care needs, such as nutrition, mobility, skin and oral care, were identified through the assessment process and ongoing monitoring. Input from healthcare services, such as the Community Nurse service, Continence Nurse service, General Practitioners and others, were recorded in individuals’ files. Those people with specific health conditions, such as diabetes, were continued to be supported to access the relevant community health services, such as chiropody and opticians. The previous inspection report highlighted that the strategies developed and implemented by the home to support people’s emotional and mental health needs were not effective as shown by the high level of negative incidents affecting people and the staff team. This issue was also affected by the staffing levels on the units and will be addressed through the Staffing Section. It was found that the guidelines for staff to follow to be able to deal with changes in people’s emotional and mental health had been reviewed and updated. It was also found that the number of aggressive incidents on the Balmoral Unit had reduced dramatically over the course of the past three months. The Windsor and Kensington Unit support many people with a range of dementia related health and emotional health needs. Trained nurses had begun the process of using a method of assessment called Dementia Mapping. Examples of these assessments were seen and also the dementia care plans that had been developed as a result of the assessment to support people to experience more positive experiences and a better quality of life. It is recommended that the use of Dementia Mapping and development of specialist care plans be fully implemented and actioned and reviewed to ensure that people were experiencing more positive experiences. Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 15 The previous two key inspection reports highlighted concerns about the way that the medication administration system was being managed and operated and could have put people’s health at risk. We had visited the home in January 2008 to find out if improvements were being made. It was found that staff who had responsibility for administering medication had received additional training from the relevant pharmacist. The manager had also developed a system for assessing staff competence and was in the process of carrying these out. An auditing system had been introduced whereby the Medication Administration Records (MAR) were checked daily to identify errors. It was also found that the home had worked with their local G.P to review people’s medication and had removed all medication prescribed as PRN that was no longer required. The medication records and systems were examined in the Kensington and Balmoral Units and found that there had been substantial improvements in the accuracy of recording and regular auditing of medication. Medication Administration Records were sampled and found to be mostly accurate and where errors had been made these had been identified through the auditing process and the reasons investigated and recorded. There was evidence of medication training and competency assessment which looked at practice issues, administration of medication and the knowledge required to administer safely. Controlled drugs were examined, and the stock levels balanced with the records. Throughout the site visit and especially on the Windsor Unit during lunch-time we observed how staff worked and interacted with people with high levels of need. The staff were positive in their use of language and how they talked and addressed people. Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were being supported to participate in greater social and leisure interaction and were encouraged to maintain links with family and friends. Mealtimes were relaxed and the majority of people enjoyed the food. EVIDENCE: The previous key inspection report highlighted concerns that had been raised by people, their relatives and staff at the home about the lack of activities and social interaction. As a result the requirement was made that people must be provided with meaningful activity and/or as part of an agreed therapeutic programme, people’s social and leisure interests must be identified and a range of meaningful activities be arranged to meet those needs with sufficient staff to implement such events and engage with people. From people’s care plans sampled at the time of the site visit it was found that people’s needs for social and leisure activities had been reassessed and identified. Also, staff had carried out a dementia mapping exercise that Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 17 identified areas of social interaction and had developed action plans to increase that activity. In the Balmoral Unit records were being kept that evidenced the activities that people participated in and included attending college courses, going to the theatre and other social trips into the community. People who were able visited local shops to buy personal items. People were also supported to go to the local park. An activities coordinator worked with people and staff on all the units supporting people to find out what they liked to do and also to encourage the staff to be more progressive in supporting social activities. The hours of the activity coordinator had been increased and another member of staff was taking on more coordinator roles. During a visit to the lounge area of the Kensington Unit, plenty of staff were seen in the right place, talking to residents and taking walks in the garden with residents. Where staff were helping people to have a drink they sat with people at the right level, making eye contact. Although the level and participation in social activities and interaction had increased it was found that on the Kensington and Windsor units the information about what activities were planned and when was difficult to find. It is recommended that the information about the activities programmes be presented to people in ways that they can clearly view and understand. During the site visit people were being visited by family and friends. There was no restriction on when people could visit and people had the choice of private and communal areas to see their guests. Several relatives were spoken to and they had some very good comments to make about the care their relatives received and the positive attitude of the staff team. People received their personal letters direct, without them being opened unless otherwise agreed. People who were independently mobile were able to access all the communal areas on the unit where they live. The main doors to units were controlled through a keypad lock and people were given the code to come and go unless this was considered to be a risk to the person. Those that could, managed their own personal finances with help and support from staff if needed. Lunchtime was observed on the Windsor unit and found it to have a relaxed atmosphere. Staff were providing one to one assistance with pleasant and meaningful conversation going on between people and staff. Several relatives present were providing support to their relative to eat. Those relatives spoken to found this was a positive experience that they wanted to be involved with. Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 18 The chef described how the menus were developed and how people were asked about the choices and options they wanted for their meals. They had worked with people and the staff from one unit to change the way that the menus were devised and how people could make their own choices. Comments from several people and relatives were very positive about the standard of food whilst there was also some comments from relatives suggesting that the quality of some meals was not always of a good standard. Also the issue of providing different options for desserts for people who had diabetes was also raised. The chef was able the explain how the meals prepared in the kitchen are mostly hand made and use low fat and low sugar ingredients so that everyone can have the same choices. It is recommended that people and relatives are continued to be consulted about the standard of meals and actions taken to address concerns and issues raised. Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The policies, procedures and staff practices were in place to allow people to raise their concerns and to try to make sure that people were protected from harm. EVIDENCE: The Complaint Policy and procedure was available through information provided to people and/or their relatives at the time of admission. The manager had introduced meetings where relatives could meet the management and raise any concerns or worries they had about the service. These meetings were being held with a small number of relatives so that everyone could have the chance to raise their own issues. Recorded minutes of these meeting were seen and found that a range of issues and concerns were raised by relatives about their relatives experience and covered areas such as meals, activities, finances and the home’s environment. It is recommended that the recorded minutes of these meeting identify the actions that have been agreed to take place and identify who was to action them and when. These complete minutes should then be sent to people and their relatives so that progress on actions can be seen as transparent. Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 20 The manager maintains a written log of all concerns and complaints received. The records showed that over the past 3 months one complaint had been made and this had been investigated and responded to. The home followed a policy and procedure set by the main organisation that sets out the roles and responsibilities of the management and staff team in responding to adult protection issues. The manager had access to the contact details of the different local authorities who placed people at the home. They were aware of their role in reporting allegations and incidents to the relevant local authority and for notifying other agencies such as the CSCI when incidents occur. Since the last key inspection four referrals had been made to the local authority in relation to concerns over people’s safety and wellbeing. The manager and staff team had followed the procedures and informed the relevant organisations. The training records showed that the majority of staff had received training in adult protection which was provided by a local authority social services training team. At the time of the site visit a number of staff were attending a safeguarding training event. Training in adult protection was also included in the home’s induction programme. Staff spoken to were aware of the issue of adult protection and of their role in reporting concerns to the management. Information about ‘whistleblowing’ was available for staff. Comments from people and their relatives through the surveys confirmed that they were aware of their rights to make a complaint and to raise their concerns and who to speak to if they were worried. Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The premises were generally clean and well maintained and the environment met people’s needs. The infection control procedures and laundry facilities appeared sufficient to maintain people’s health and safety. EVIDENCE: The previous inspection report highlighted the issue that the home in general was in need of some investment in maintaining and improving people’s environment. Concerns had been raised at the time of that key inspection and through subsequent comments made by relatives of unpleasant smells on the ground floor Kensington Unit and 1st floor Balmoral Unit. At the time of the site visit there was no malodorous smells in any of the units and the home appeared to be clean and tidy. After the last key inspection staff Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 22 on the Balmoral unit had redecorated one of the large bathrooms which now appeared light, airy and domestic in decoration. It was noticed that most parts of the home were uncomfortably warm with the need for additional ventilation in several communal areas. The manager stated that the company that owns the home, Four Seasons (Bamford) Limited, had identified resources to provide for an extensive refurbishment programme within the home and this included ventilation issues. However, at the time of the site visit no date or schedule of works had been agreed. The issue of how people can become involved in the choices and decision making regarding the refurbishment was discussed with the manager as well as how the environment impacts on people with dementia needs. It is recommended that an action plan and schedule of works of the proposed refurbishment programme be provided to the commission. It is also recommended that the home evidence how people are fully consulted over the choices in the refurbishment of their home and that the refurbishment plans show clearly how research and good practice guidance in relation to dementia care have been incorporated. A number of people on the Balmoral Unit were smokers, however, there is no designated smoking room on that unit. If people wished to smoke, they had to leave the unit and walk through another unit to access the outdoor garden areas. The manager stated that plans were in place to provide people living on the Balmoral Unit with a separate exit/entrance for them to access the garden and smoking area. This would avoid people from the unit having to walk through the Kensington Unit on the ground floor. The infection control procedures and laundry facilities appeared sufficient to maintain people’s health and safety. Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported by a staff team that have the knowledge and skills to meet their needs. The systems for making sure that staff are safe to work with vulnerable people needs to follow the set policies and procedures of the home in terms of references. EVIDENCE: The previous key inspection highlighted serious concerns about the staffing levels within the home, especially on the Balmoral Unit, that could place people and staff at risk. An Immediate Requirement was issued at the time for the home to make immediate improvements. The Random Inspection carried out in January 2008 found that increases in staffing had taken place throughout the home. At the time of the site visit the staffing levels on the units were: Balmoral Unit had two nurses and three care staff during the day, The Windsor Unit had one or two nurses with five care staff during the day and this could include a more flexible working pattern to provide more staff at the busiest Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 24 times such as meal times, getting up and going to bed. The Kensington Unit had two nurses and six care staff on duty. The home benefited from a full team of domestic and catering staff. In all cases this reflected an increase in staffing levels and flexibility to provide staff when people needed the most help. In addition the home had a dedicated domestic team and catering team. The Activity Coordinators hours had been increased and the manager was in the process of appointing further hours to the activity coordinator role. The increase in staffing levels contributed to a more relaxed atmosphere on all the units and staff were observed spending more time with people in social interaction rather than doing tasks all the time. This had also impacted on the number of incidents/accidents that occurred in the home. The manager had maintained a log of all incidents affecting people and found that in the last three months the number of negative incidents had reduced by almost 50 over the previous three months. Information provided by the home through the AQAA self-assessment confirmed that 14 of the 40 non-qualified staff had achieved the NVQ level 2 with two staff undertaking the course. It is recommended that staff are supported to undertake and gain the relevant vocational qualification. The home is part of a large organisation called Four Seasons Ltd and so follow the corporate recruitment policies and procedures. It was stated that it was corporate policy to start employing staff within the home after gaining a POVA First check and two references. It appeared that this was standard practice even though the use of the POVA First arrangements were meant to be for emergency situations. It is recommended that the use of POVA First is based on the Department of Health Guidance. Three files of staff who had recently started employment at the home was checked. All had a Criminal Records Bureau (CRB) certificate and POVA First check. However, one of the staff files only contained one reference and another contained references that did not relate to the persons previous employment (even though this was the recruitment policy). To make sure that staff are safe to work with vulnerable people all the required checks and documentation stated in the recruitment policy must be gained prior to staff starting work. All new care staff undertook the corporate Induction programme that was based on the Skills for Care Induction modules. During the induction period new staff have a mentor who works with them in assessing whether they have gained the knowledge and skills from the induction training. The mentor then assesses whether the person is competent in those areas. The Induction Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 25 programme covers key areas such as adult protection, health and safety, moving and handling and roles and responsibilities. Ongoing core training was being provided in areas such as first aid and fire safety. The home had access to training provided by Stockport NHS and the Local Authority multidisciplinary training and development programme e.g. infection control and managing risk. Following every training session staff were required to fill in a competency document to check their knowledge. Issues arising from this are followed up in supervision. It is recommended that a formal system for assessing the competence of staff in applying the knowledge and skills they learn through training events be implemented. Each member of staff has a separate record of what training they have participated in and one of the unit managers was responsible for maintaining this record. However, there was no system that identified clearly when staff required refresher training or to update their knowledge. It is recommended that the home develop a staff team training plan that looks ahead at staff training needs and allows for the planning and provision of refresher and updated core training. Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs were supported and they were protected. People were encouraged to give their views on the service they received. The manager and management team had the necessary qualifications, skills and values to run the home in the best interests of the residents. EVIDENCE: The previous key inspection report raised concerns about the overall management of the service in terms of contradictory understanding on certain key issues, such as the admission process for contracted beds, the use of agency staff and management supernumerary hours, which brought into Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 27 question the communication within the overall management of the organisation about the problems being faced. In January 2008 we made a random visit to the home to find out what improvements had been made. At the time of that visit the manager and the acting regional manager were on site. The acting regional manager had been providing the manager with support since the completion of the previous key inspection site visit and was the previous manager of the home. Through discussions with the manager it was evident that they had a clear understanding of the issues they faced and felt that those issues were being taken seriously by Four Seasons Health Care. Additional resources had been made available to address the immediate concerns regarding the staffing levels and further resources were going to be made available to address other environmental issues. At the time of this site visit the manager had successfully applied to become the registered manager of the home and a senior manager from the organisation was providing ongoing support and guidance to the home. The management structure of the home consisted of the registered manager, a deputy (who was also the unit manager of the Kensington Unit) and managers for the Windsor and Balmoral Units. The manager had continued to implement monitoring and auditing systems for the medication and care planning and assessment systems to make sure that quality was being maintained. Also she was having informal daily and regular formal meetings with the management of all departments in the home to make sure that information and communication was effective. Comments from staff were positive about the support they received from the manager and management team whom they saw on a regular basis through meetings and supervision. The home has a formal Quality Assurance system developed by the Four Seasons Health Care called a ‘Team Audit’. This involved members of the staff team auditing the operational quality of the service. This information is used to develop an action plan to address any issues or problems found in the way that the home operates. In addition, the home has a range of informal systems to find out and maintain the quality of the service it provides. The Balmoral Unit holds regular residents meetings to discuss issues such as the food, activities, finances and the proposed refurbishment. The meetings with small groups of relatives has been highlighted in the Complaint and Protection section of the report. Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 28 A senior manager in the organisation undertakes monthly checks under Regulation 26 of the Care Homes Regulations. The home have been providing us with copies of these visits and they are required to continue to do so to provide us with information of the home’s progress in maintaining standards. Each unit maintains an individual record of people’s spending on personal items. Records were accurate and receipts or invoices were available. The records were regularly monitored and checked to make sure they were accurate. The administrator maintains a computerised record system of all monies that come into the home and given out to people. Either families or the purchasing local authority held the appointeeship for all but one person. It was noticed that some people’s balances were higher than they should be. The administrator was aware of this issue and was trying to resolve it. It is recommended that the home continue to make sure that people’s personal finances was being maintained within agreed levels and in accordance with any relevant benefit regulations. According to the AQAA document provided by the home, equipment and services were being serviced and checked on an ongoing basis. Policies and procedures relating to health and safety were in place. Fire log records of the required checks was being made. Kitchen safety was being monitored and recorded according to the relevant health and safety regulations. Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 30 No Are there any outstanding requirements from the last inspection? 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 OP29 Regulation 19(1) Requirement To make sure that staff are safe to work with vulnerable people all the required checks and documentation stated in the recruitment policy must be gained prior to staff starting work. So that the progress of how the home is improving can be monitored, Regulation 26 inspection visit records must be submitted to the CSCI every month until further notice. Timescale for action 30/06/08 2. OP33 24(1)(2). 30/06/08 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 Refer to Standard OP3 Good Practice Recommendations It is recommended that the management make sure that before anyone comes to stay at the home clear, detailed and person centred information about the persons needs is DS0000068318.V362895.R01.S.doc Version 5.2 Page 31 Bamford Grange Care Home gathered through the purchaser and/or their own assessment process to make sure that they have the service and staffing to meet people’s needs. 2 OP7 It is recommended that the involvement of people and their family/representative the care planning and review process be clearly recorded to show how people have been consulted and involved. It is recommended that the use of Dementia Mapping and development of specialist care plans be fully implemented and actioned and reviewed to ensure that people were experiencing more positive experiences. It is recommended that the information about the activities programmes be presented to people in ways that they can clearly view and understand. It is recommended that people and relatives are continued to be consulted about the standard of meals and actions taken to address concerns and issues raised. It is recommended that the recorded minutes of e meetings with relatives identify the actions that have been agreed to take place and identify who was to action them and when. These complete minutes should then be sent to people and their relatives so that progress on actions can be seen as transparent. It is recommended that an action plan and schedule of works of the proposed refurbishment programme be provided to the CSCI. It is also recommended that the home evidence how people are fully consulted over the choices in the refurbishment of their home. It is also recommended that the refurbishment plans show clearly how research and good practice guidance in relation to dementia care have been incorporated. It is recommended that the needs of people who smoke and wish to continue to do so are addressed and, taking into account the relevant regulations and legislation, suitable facilities be provided that do not impact on other people. 3 OP8 4 5 OP12 OP15 6 OP16 7 OP19 Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 32 8 9 OP29 OP30 It is recommended that the use of POVA First is based on the Department of Health Guidance. It is recommended that a formal system for assessing the competence of staff in applying the knowledge and skills they learn through training events be implemented. It is recommended that the home develop a staff team training plan that looks ahead at staff training needs and allows for the planning and provision of refresher and updated core training. 10 OP35 It is recommended that the home continue to make sure that people’s personal finances was being maintained within agreed levels and in accordance with any relevant benefit regulations. Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Bamford Grange Care Home DS0000068318.V362895.R01.S.doc Version 5.2 Page 34 - 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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