Care Home: Bank House Nursing Home

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What the care home does well Good information was gathered before people were admitted to the home so that staff were provided with a clear picture of individual needs to ensure that they were confident that the care and support required could be delivered. The plans of care provided staff with clear guidance about how the assessed needs of people living at the home were to be met and how people could be supported to maintain their privacy and dignity. A variety of external professionals had been involved in the care of people living at Bank House to ensure that their health care needs were being appropriately met. The routines of the home were very flexible and activities were arranged within the home for those who wished to participate. Relatives spoken to were happy about how visitors were received into the home and they told us that the staff were all very friendly, kind and caring. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so require and people living at the home were able to have some control over their lives by managing their own finances, should they so wish. People living at the home were provided with nutritious, well balanced meals so that their dietary intake was adequate and those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. The complaints procedure was freely available within the home and it was also included within the service users` guide so that people were given enough information about how they could make a complaint should they so wish. The policies and procedures in relation to safeguarding vulnerable adults were easily accessible and staff spoken to knew the procedure to take should an allegation of abuse be received by the home. The home was nicely furnished and pleasantly decorated and the premises, both internally and externally were well maintained providing those living at Bank House with a safe, clean, comfortable and homely environment. Effective infection control measures were in place to ensure that the health and safety of people was adequately protected. Staff received a good induction programme so that they were confident to do the job expected of them. A lot of training was provided for people working at the home in order for them to maintain their knowledge and skills, so they could effectively support the people in their care. The home was managed in the best interests of those living at Bank House and the quality of service provided was thoroughly monitored so that any shortfalls could be easily identified and addressed as was appropriate. The health, safety and welfare of people living at the home was protected within a risk management framework, to ensure that any hazards, which could pose a potential risk, were minimised or eliminated. When asked what the service does well comments received by staff included, `it gives good care to all the people who live at Bank House`, `it supports residents, their families and staff well. We have regular supervision to identify training needs. Regular training is readily available. Staff are encouraged to reach their full potential. Bank House provides a warm and friendly atmosphere for all service users and their families`, `the service provides an excellent quality of care and it supports staff in all aspects of working life` and `good organisation, good choice, good activities, clean environment and good communication`. When asked if there was anything else they would like to tell us one relative wrote on the comment card, `the home and staff are all first class and this is all due to the senior sister. She runs the dementia care unit smoothly and easily, but always with a smile`. What has improved since the last inspection? There were no requirements made at the last key inspection and one of the two recommendations had been appropriately addressed in relation to medicine management. One requirement had been issued at the random visit to this service. However, on this occasion we found that this had been fully met. All staff had been made aware of individual care plans and preferences for morning routines, which was confirmed by our early morning visit to the service. Oxygen cylinders were no longer stored at the home so there was not an issue on this occasion with Health and Safety matters. Hand written entries on the Medication Administration Records included the drug dosage instructions alongside two signatures for accuracy and safety. What the care home could do better: People living at the home or their relative could have been given the opportunity to be involved in the care planning process so that they could have some input in to planning their own care. The carpet in the first floor corridor was worn in places and not in good condition and was therefore in need of replacing. The paintwork could have been better as it was `scuffed` and peeling off in some areas of the home. The number of care staff with a recognised qualification in care could have been higher, so that the home provided a more qualified workforce as a whole, in order to have sufficiently skilled people to supervised the unqualified care staff. Risk assessments in relation to safe working practices and the policies and procedures of the home could have been reviewed and updated more frequently so that staff were always given up to date guidance about new ways of working. The recruitment practices could have been better by ensuring that all required checks were undertaken before new staff started working at the home, including Criminal Record Bureau disclosures so that the home was sure that people living there were protected. Written references should be dated so that evidence is available to show that they have been received before people started to work at the home. When asked what the service could do better the majority of staff responded by expressing their feelings about the staffing levels at the home and the pressures of work. Comments received included, `to provide more staff at certain times of the day`, `there could be more staff at certain times, although care is not compromised` and `more staff, both carers and qualified to meet the needs of increasing dependency of residents and new admissions. The upper managers with no nursing background do not appear to appreciate the amount of care needed by our residents and time needed by qualified staff to complete regulatory documentation. Qualified staff are always under pressure to complete increasing workloads`. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bank House Nursing Home Shard Lane Hambleton Near Blackpool Lancashire FY6 9BX     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vivienne Morris     Date: 2 1 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Bank House Nursing Home Shard Lane Hambleton Near Blackpool Lancashire FY6 9BX 01253701635 01253701751 ogdenv@bupa.com www.bupa.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): BUPA Care Homes (Partnerships) Limited care home 50 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Dementia - Code DE. The maximum number of service users who can be accommodated is: 50. Date of last inspection Brief description of the care home Bank House Nursing Home is situated within its own grounds, very close to the rural village of Hambleton, where there are shops and local facilities such as a garage and a public house. The home provides accommodation for up to 50 elderly people who have Care Homes for Older People Page 4 of 33 Over 65 0 50 50 0 2 2 0 9 2 0 0 8 Brief description of the care home nursing needs or needs associated with a dementia related illness. There is a Statement of Purpose, Service Users Guide and Information Pack that are given to all those considering going to live at Bank House. This is a set of written information that tells people about the services that are offered, the facilities available and what people moving in to the home can expect life to be like at Bank House. The most recent inspection report is available in the reception area of the home so that people can read about what the Care Quality Commission found at their last key inspection. All private accommodation is provided in single bedrooms, some of which have en-suite facilities. Each room is furnished to a good standard. There are adequate bathrooms and toilets throughout the home. The home comprises of ground and first floor accommodation and the lounge and dining areas are decorated and furnished to a good standard. There are three pleasant dining/lounge areas, two on the general nursing unit and one on the dementia care unit. A passenger lift is available for the less mobile and and wheelchair access is provided throughout the home. The gardens are well maintained and there is adequate car parking space. The fees as of 21st April 2009 ranged from £405.50 to £652 with some additional costs for hairdressing, newspapers and chiropody. Care Homes for Older People Page 5 of 33 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 key inspection to this service took place on 1st August 2007. The quality rating for this service is three star. This means that people who use this service experience excellent quality outcomes. The site visit to Bank House formed part of the inspection process and was conducted over one day in April 2009. It was unannounced, which means that the managers, staff and people living at the home did not know it was going to take place. During the course of the site visit, discussions took place with those living at the home, as well as relatives, staff and managers. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas were seen. Care Homes for Older People Page 6 of 33 Comment cards were received from six people who were living at the home and eight staff members and their feedback is reflected throughout this report. Every year the provider completes a self-assessment, known as an AQAA, which gives information to the Commission about how the service is meeting outcomes for the people living at the home and how the quality of service provided is monitored. We observed the activity within the home and tracked the care of four people during the site visit, not to the exclusion of other people living at Bank House. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service over a period of time. The Care Quality Commission had received one complaint about this service since the last key inspection, which resulted in a random visit being conducted. Two issues were also referred to social services under safeguarding procedures. What the care home does well: Good information was gathered before people were admitted to the home so that staff were provided with a clear picture of individual needs to ensure that they were confident that the care and support required could be delivered. The plans of care provided staff with clear guidance about how the assessed needs of people living at the home were to be met and how people could be supported to maintain their privacy and dignity. A variety of external professionals had been involved in the care of people living at Bank House to ensure that their health care needs were being appropriately met. The routines of the home were very flexible and activities were arranged within the home for those who wished to participate. Relatives spoken to were happy about how visitors were received into the home and they told us that the staff were all very friendly, kind and caring. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so require and people living at the home were able to have some control over their lives by managing their own finances, should they so wish. People living at the home were provided with nutritious, well balanced meals so that their dietary intake was adequate and those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. The complaints procedure was freely available within the home and it was also included within the service users guide so that people were given enough information about how they could make a complaint should they so wish. The policies and procedures in relation to safeguarding vulnerable adults were easily accessible and staff spoken to knew the procedure to take should an allegation of abuse be received by the home. The home was nicely furnished and pleasantly decorated and the premises, both internally and externally were well maintained providing those living at Bank House with a safe, clean, comfortable and homely environment. Effective infection control measures were in place to ensure that the health and safety of people was adequately protected. Staff received a good induction programme so that they were confident to do the job expected of them. A lot of training was provided for people working at the home in order for them to maintain their knowledge and skills, so they could effectively support the people in their care. The home was managed in the best interests of those living at Bank House and the quality of service provided was thoroughly monitored so that any shortfalls could be easily identified and addressed as was appropriate. The health, safety and welfare of people living at the home was protected within a risk management framework, to ensure that any hazards, which could pose a potential risk, were minimised or eliminated. Care Homes for Older People Page 8 of 33 When asked what the service does well comments received by staff included, it gives good care to all the people who live at Bank House, it supports residents, their families and staff well. We have regular supervision to identify training needs. Regular training is readily available. Staff are encouraged to reach their full potential. Bank House provides a warm and friendly atmosphere for all service users and their families, the service provides an excellent quality of care and it supports staff in all aspects of working life and good organisation, good choice, good activities, clean environment and good communication. When asked if there was anything else they would like to tell us one relative wrote on the comment card, the home and staff are all first class and this is all due to the senior sister. She runs the dementia care unit smoothly and easily, but always with a smile. What has improved since the last inspection? What they could do better: People living at the home or their relative could have been given the opportunity to be involved in the care planning process so that they could have some input in to planning their own care. The carpet in the first floor corridor was worn in places and not in good condition and was therefore in need of replacing. The paintwork could have been better as it was scuffed and peeling off in some areas of the home. The number of care staff with a recognised qualification in care could have been higher, so that the home provided a more qualified workforce as a whole, in order to have sufficiently skilled people to supervised the unqualified care staff. Risk assessments in relation to safe working practices and the policies and procedures of the home could have been reviewed and updated more frequently so that staff were always given up to date guidance about new ways of working. The recruitment practices could have been better by ensuring that all required checks were undertaken before new staff started working at the home, including Criminal Record Bureau disclosures so that the home was sure that people living there were protected. Written references should be dated so that evidence is available to show that they have been received before people started to work at the home. Care Homes for Older People Page 9 of 33 When asked what the service could do better the majority of staff responded by expressing their feelings about the staffing levels at the home and the pressures of work. Comments received included, to provide more staff at certain times of the day, there could be more staff at certain times, although care is not compromised and more staff, both carers and qualified to meet the needs of increasing dependency of residents and new admissions. The upper managers with no nursing background do not appear to appreciate the amount of care needed by our residents and time needed by qualified staff to complete regulatory documentation. Qualified staff are always under pressure to complete increasing workloads. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 10 of 33 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 11 of 33 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. Peoples needs are thoroughly assessed before they are admitted to the home to ensure that the staff team can deliver the appropriate care. Evidence: A wide range of information was displayed within the home telling people about the facilities available at Bank House, the quality of service provided and general points of interest, so that people could make an informed choice about moving in to the home. All six people who submitted comment cards and who were using the service said that they received enough information about the home before they moved in to allow them to decide if it was the right place for them to live. Whilst we were at the home one person arrived for admission with his relatives. He was welcomed to Bank House in a warm and friendly manner. The nurse who had visited him and who had conducted his needs assessment before admission had come Care Homes for Older People Page 12 of 33 Evidence: to the home on her day off specially to greet him and help him settle in, which was considered to be very good practice. One person spoken to said that someone from the home had visited them before they went to live at Bank House and on the day of our visit another nurse went to assess the needs of someone in the community who wanted to move in to the home to determine if their needs could be met. The acting manager of the home told us what the service does well in this area. She provided some good examples of how this was achieved. We looked at the care records of four people living at the home. Good information had been gathered about the needs of people before they moved in to the home to ensure that the staff team could provide the care and support required by each individual admitted. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs were fully met, their privacy and dignity being respected at all times and the management of medications was good. Evidence: Over the course of the day we spoke at some length with many people living at the home and their relatives about the care they received and we observed the general day to day activity within the home. The care plans seen were very detailed and person centered, being based on the information collected in the assessment period before admission to the home to ensure that all assessed needs were taken in to consideration. Clear guidance was provided for staff as to how peoples needs were to be met. One person spoken to whose care plan we looked at was certainly very happy with care provided and her care plan reflected the support she needed accurately. All eight staff members who sent us comment cards said that they were always given up to date information about the needs of people they supported. One of these people Care Homes for Older People Page 14 of 33 Evidence: wrote, we are given up to date information about the needs of people we care for at the start of every shift and another commented, we are always told before we start our shift about any changes with the residents or their care plans. All these members of staff also said they felt, in general, that they had the right support, experience and knowledge to meet the different needs of people who use the service. One wrote on the comment card, my manager helped me a lot so that I can look after the residents well and another commented, we have an excellent senior sister. All residents needs are considered and cared for. The plans of care had been reviewed regularly and any changes in peoples needs were reflected well. However, they had not always been developed with the involvement of the person using the service or their relative so that those living at the home were able to plan their own care. The health care needs of people were recorded well and a wide range of external professionals were involved in the care provided to those living at Bank House, so they received the health care that they needed. Medications were being managed appropriately so that people were protected from any errors or drug misuse. All six people who sent us comment cards and who were using the service said that the staff always treated them well. One relative wrote on behalf of someone living at Bank House, the staff here all go out of their way to do all those extra little things that make my relatives life comfortable and pleasant and when asked if there was anything else they would like to tell us another relative commented, my husband is looked after extremely well in Bank House Nursing Home and I would have no hesitation in recommending it to anybody who needs to be looked after. One person living at the home said, I am being well looked after and all my needs are being met and another told us, they (the staff) are all really nice and they will do anything for me. We spoke with five visitors during the course of the day, who were all very satisfied with the care provided for their relatives. All necessary risk assessments were in place, which included details of numbers of staff required to provide support, showing that any potential risks had been identified and strategies put in place to protect those living at the home. The acting manager told us what the service did well and provided some good examples to support the information she gave to us. She wrote on the homes selfassessment, Privacy and Dignity are of high importance to us and feature in the Care Homes for Older People Page 15 of 33 Evidence: companys customer service programme Personal Best. We saw that those living at the home had a good rapport with staff and that staff spoke to them in a respectful manner and treated them courteously by knocking on their bedroom doors before entering so that their privacy and dignity was protected. Policies and procedures were in place in relation to maintaining peoples privacy and dignity and information was given to people living at the home and their relatives about the importance of respecting peoples wishes. A policy was in place in relation to equal opportunities and non-discriminatory practices to ensure that everyone living at the home were treated the same and were provided with the same opportunities. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily routines of the home were flexible and people were encouraged to maintain their leisure interests and activities whilst living there. The management of meals was good and visitors were made welcome to the home. Evidence: We arrived at the home in the early hours of the morning because since our last inspection we had conducted an early morning random visit in response to concerns raised about people being got up very early in the morning against their wishes. Improvements were quite evident since our random visit to the service as on this occasion there was no evidence of a systematic approach to getting people up in the morning. As we toured the premises we saw that only five people were up and dressed or awake. We spoke to all five of these people, four of them told us they were happy to be out of bed and the fifth was not quite sure. The social care needs of people moving in to the home had been assessed very well by the use of, a map of life, which described any significant events in peoples lives and told us about the people important to them. The map of life also told us about individual leisure interests and hobbies as well as their life history. Collectively this information provided a clear pen picture about peoples lives throughout the ages. Care Homes for Older People Page 17 of 33 Evidence: There was a lot of evidence available to show that a wide range of activities were available for people wishing to join in. The activity co-ordinator was well organised and planned events ahead very well. We were told about how the home celebrated special events and about the themed activity days during the year. Trips out were arranged at intervals when transport was hired to take people to local places of interest. One person living at the home had his own transport so that staff could take him out and about. The environment was very homely and comfortable. We were impressed with the surroundings for those living on the dementia care unit, Garden Court. Furnishings, pictures, ornaments, interactive displays and the reminiscence room promoted the wellbeing and comfort for the people living on this unit. Equality of care was being given to the people living on Garden Court in that social and therapeutic activities were provided to make daily life stimulating and content. However, one relative visiting someone living on Garden Court felt that the dementia care unit missed out on a lot of the activities, which all seemed to be concentrated in the other part of the home. He felt that staffing levels were too low to give staff opportunities to support people living on Garden Court in activities. We discussed future plans for Garden Court with the manager of this unit, who was extremely motivated to provide the right environment for people with dementia so that their lives were as enjoyable as possible. The activities programme was displayed in the home so that people could decide what events they would like to join in and so that they could plan their days ahead. Those living at the home told us that they were able to decide their own daily routines and they were happy with the range of activities provided. Discussions with staff showed that they welcomed the opportunity to be involved in the planning and implementation of social and therapeutic activities. However, one person living at the home said, there is not much to do, but I dont get bored as I spend a lot of time reading my books. The information pack provided to people contained details about visiting arrangements, showing that relatives and friends were able to visit at any time and that contact with the local community was regularly encouraged, such as visits from religious ministers and local school children. Information about local advocacy services was easily accessible within the home, so that people were aware of how to access someone to act on their behalf, should they wish to do so. One group of visitors Care Homes for Older People Page 18 of 33 Evidence: spoken to said that they are always made to feel welcome by staff. The food provided at the home was appetising and nutritious and there was plenty of choice. The dining rooms were light and nicely furnished, with pleasant table settings. Those we talked to told us that the food was good and that they were happy with the choices that were on offer. Lunchtime was a very relaxed, enjoyable experience for those living at the home and people were offered the daily choice of food. Staff were very aware of the likes and dislikes of those who were unable to make their own choices. The management of meals was good. We observed lunch being served in Garden Court. Staff were very sensitive to the needs of people living on this unit, especially a new admission. Quiet encouragement was given, which people responded to positively. One person living at the home said, the meals are very good and I always enjoy them. All six people who sent us comment cards and who lived at Bank House said that they can do what they want to do whilst living at the home. One person added, with help from the carers. One relative wrote on the comment card on behalf of a person living at the home, my husband is allowed to walk about as he wishes and is only restricted when necessary for his own protection and another commented, the staff are brilliant and they help me in any way they can with my relative. Care Homes for Older People Page 19 of 33 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. Complaints were managed well and people living at Bank House were adequately safeguarded by the robust policies and procedures adopted by the home. Evidence: There was a clearly displayed and easily accessible written complaints procedure for the people living at the home and their relatives and this was included in the homes information pack. All six people who sent us comment cards and who lived at the home told us that, in general, the staff listened to them and acted up on what they said. All six said that they would know who to speak to if they were unhappy and they would know how to make a complaint if they needed to do so. People who we spoke to said that they had no complaints at all about the service provided and that they were quite happy with the care and support received. However, they said that they would know what they needed to do should they wish to make a complaint. There was information readily available about the use of advocacy services and where people could get advice if they needed it. The advocacy service is used for anyone who would like an independent person to act on their behalf so that they are given the same opportunities as others and so that their affairs are protected. The home had Care Homes for Older People Page 20 of 33 Evidence: started working towards implementing strategies around the Mental Capacity Act so that everyone living at the home were given the same opportunities. There were policies and procedures in place for the Protection Of Vulnerable Adults and the training matrix showed that most of the people working at the home had been given training on abuse awareness. All eight staff members who sent us comment cards and those we spoke to on the day of our visit told us that they would know what to do should a person living at Bank House, their relative, advocate or friend be concerned about the welfare of someone living at the home. Evidence was available to show that where complaints or safeguarding adult issues had been raised, the management team at the home dealt with them in accordance with agreed polices and procedures and in an effective and efficient manner. Systems for recording any such issues were satisfactory. However, action taken when investigating a complaint was not always recorded to show how the outcome had been determined. When asked what the home could do better the acting manager told us, we could ensure that staff refer all concerns. We could evaluate and act on feedback. We could achieve 100 percent of staff trained in the Protection Of Vulnerable Adults, the Mental Capacity Act, Documentation and Management of Violence and Aggression. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided a safe and comfortable environment for the people living there. Evidence: All lounges, dining areas and bedrooms were very homely, comfortable and furnished to a good standard, providing a nice place for people to live. It was evident that an ongoing programme of maintenance was in place because most of the home was decorated to a satisfactory standard. However, some areas were in need of painting, such as the door to the dining room on the first floor and some areas of the walls, which had scuff marks on them. The corridor carpet on the first floor was marked in places and areas were worn, so this was ready for replacing so that the standard of environment on the first floor matched that of the rest of the home. Bank House in general was clean, tidy and pleasant smelling providing people with hygienic conditions in which to live. People we spoke to said that they were happy with their bedrooms and the communal areas of the home. The bedrooms we viewed were very clean, nicely furnished with personal affects displayed so that a comfortable and homely environment was provided for those living at Bank House. There were aids and adaptations such as grab rails in toilets and special moving and handling equipment, as well as bathing hoists for the people who needed additional Care Homes for Older People Page 22 of 33 Evidence: help with their mobility. The laundry department was well organised and sufficient equipment was provided to ensure a good laundry service was provided for the people living at the home. Relevant policies and procedures were in place to support the homes practices of protecting people from cross infection. When asked if the home was fresh and clean all six of the people using the service indicated on the comment cards that, in general, it was. The acting manger told us what the home does well by writing on the self-assessment, we provide equipment, aids and adaptations in line with the needs of the residents. We have an ongoing programme of redecoration of bedrooms, and other areas within the home. We use a specialist microfiber cleaning system that combined with effective cleaning regimes keeps the home clean. Comprehensive policies and procedures include infection control and handling of clinical waste. The home is supported in maintaining the environment by a central team of experts, including estates department, property and hotel services. We have an in-house laundry facility. We employ separate housekeeping staff. Care Homes for Older People Page 23 of 33 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. At the time of our visit to this service the number and skill mix of staff on duty met peoples assessed needs and those working at the home had received some good training so that they could do their jobs properly. Evidence: The number of people on duty was calculated in accordance with the assessed needs of those living at Bank House to ensure that they received the care and support required. However, we spoke to one visitor, who was very concerned about the staffing levels on Garden Court. He told us that there were usually three members of staff on duty in this area and that they are often all busy, but he was also very appreciative of the the efforts of the staff and he told us that they were very well motivated and organised and that the team leader was very effective. Two complaints about staffing levels had been recorded in the complaints log book. We spoke to a group of three visitors who were all very happy with the attitude of staff. The lady they were visiting said herself that staff were very good and that she was impressed with the staff and found them very helpful. We spoke to the team leader on Garden Court, who clearly enjoyed her job and she evidently took a great pride in what she did. We observed the staff team respond exceptionally well to her leadership and positive attitude, which was pleasing to see. Care Homes for Older People Page 24 of 33 Evidence: When asked if there were enough staff to meet the individual needs of all the people who use the service the responses from staff members who sent us comment cards were mixed. One staff member wrote, more staff are needed at certain times and another told us, the manager always checks that we have enough staff on duty or in case of short notice sickness she always tries to get an extra member of staff to cover. At the time of our visit to this service there were 30 care staff employed, ten of who had completed a recognised qualification in care. The home was working hard toward achieving the recommended level of 50 , so that enough care staff were appropriately qualified to deliver the care required and to oversee the support provided by unqualified care staff. All eight staff members who sent us comment cards told us that their employer had carried out checks, such as Criminal Record Bureau (CRB) disclosures and references before they started work. One of these people told us, my CRB and references were checked out before I started work at the home. We looked at the personnel records of three staff members. In general appropriate checks were in place. However, one written reference for one member of staff was not dated, so it was not possible to establish if this had been received before employment commenced. All other checks for this employee had been obtained before they started working at the home. Although the home had conducted checks of the Protection Of Vulnerable Adults (POVA) register before people started working at Bank House, two out of the three files examined showed that the Criminal Record Bureau (CRB) disclosures had been received after employment commenced. There was no documented evidence on the staff files to show that these people had been constantly supervised whilst waiting for their CRB disclosures. The CRB guidance states that people must only be employed before a full CRB disclosure is received in exceptional circumstances and therefore evidence of this needs to be recorded along with detailed supervision records so that people living at the home are always protected. Two people spoken to said that they received plenty of training relevant to their roles, which was mandatory and also training which was relevant to the assessed needs of people in their care. The induction period was very thorough to ensure that new staff knew how to do the job properly. Records showed that a wide range of training was provided for staff at Care Homes for Older People Page 25 of 33 Evidence: Bank House so that they were kept up to date with new ways of working. Six of the eight staff members who sent us comment cards said that their induction covered everything they needed to know very well. The other two said it covered mostly everything. One person wrote on the comment card, yes, my induction covered everything very well and if we are unsure about anything we only need to ask and another person commented, all policies and procedures were covered on my induction. All eight staff members who submitted comment cards said that they were given training which was relevant to their role and which helped them understand and meet the individual needs of the people living at Bank House. One of these people wrote, we have ongoing training called Personal Best, which is always updated. Specialised training is also provided about residents needs and another told us, we get up to date training on all aspects of the job. When asked what the service could do better, the acting manager wrote on the homes assessment, we could improve the level of NVQ training. We could develop a bank staff list to cover shifts at short notice. We could reduce the amount of agency staff used and reduce the level of sickness and absence. Care Homes for Older People Page 26 of 33 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 home was managed well so that the health, welfare and safety of the people living and working there was protected. Evidence: The home was being well managed and staff spoken to told us that they were well supported by the managers of the home and that there was a good rapport between the staff and the people living at Bank House, which was quite evident from the very happy and friendly environment, which was full of fun and laughter whilst we were there. Bank House was clearly being run in the best interests of those living there and people using the service and visitors to the home all spoke very highly of the staff and the managers of the service. When asked if the management of the home supported staff and discussed with them how they were working, one member of staff wrote on the comment card, we have a very supportive senior sister. She continues to give us support in our work areas as she works with us, another commented, my manager does supervisory meetings. Care Homes for Older People Page 27 of 33 Evidence: Also I can approach her whenever I need to as she is very supportive and a third stated, all the time my manager is very good. She tells me all about dementia care and how to work. When asked if there was anything else they would like to tell us, one member of staff wrote on the comment card, everyone works together as a team and another commented, the only thing I would like to add is that all of the senior members of staff run the home very well especially the two unit managers and the current acting home manager, who has coped very well with taking on the role and responsibility of the previous manager, who was also excellent. There was an excellent system in place for monitoring the quality of service provided, which included a wide range of risk assessments and audit trails so that any potential risks, strengths or areas for improvement could be identified and addressed as was necessary. A variety of meetings were held at regular intervals, with minutes retained, so that people concerned could pass on any relevant information and discuss any topics of interest. Some surveys had been conducted for people using the service and their relatives so that those living at the home could say what it was like living at Bank House. It may be beneficial to now invite staff members and stakeholders in the community to complete surveys so that they can provide feedback about what it is like working at the home and how peoples goals are being met by the service provided. The results of surveys conducted were corrolated and presented in an easy format so that any interested parties could see what the outcomes for people living at the home were like. The service had achieved an accredited quality monitoring award, which means that the home is assessed at regular intervals by an external organisation as to the quality of service provided for the people using it. A representative from the company had conducted unannounced inspections each month so that any strengths or areas for development could be identified and addressed as necessary. Clear computerised records were kept in respect of two people living at Bank House whose money was managed by the home, showing any transactions of debit or expenditure, with receipts being retained. Generally relatives were sent invoices when money was owed and all payments were made by cheque so that there was little handling of money belonging to those living at the home to ensure that peoples financial interests were safeguarded. Care Homes for Older People Page 28 of 33 Evidence: We saw that there was a detailed fire zone plan displayed near the fire alarm panel and that a clear fire procedure was in place at the home, which included an emergency evacuation plan. A fire risk assessment had been conducted and staff had been provided with appropriate training so that they were aware of action to take in the event of a fire breaking out. A recent fire safety inspection report showed that a number of items needed to be addressed. We were told that the home was in the process of deciding on a plan of action to address the issues highlighted by the fire officer. A random selection of service certificates were examined, which showed that systems and equipment within the home had been appropriately checked by external contractors to ensure that they were safe for use so that those using them were protected from harm. An extensive range of internal checks had also been conducted so that people living at Bank House and those working there were kept safe. A clear record of accidents and injuries was maintained with statistics being collated quarterly so that any emerging trends or patterns could be easily identified and addressed as was necessary. A wide range of training had been provided for staff in relation to Health and Safety issues, so that they knew what they should do to maintain a safe environment for the people living at the home. There were a lot of risk assessments in place in relation to safe working practices as well as a wide range of policies and procedures, which were detailed and provided staff with clear guidance about a variety of clinical, operational and Health and Safety matters. However, some of these were not dated and although others had been reviewed it is recommended that they should be updated more regularly so that staff are provided with current information. Care Homes for Older People Page 29 of 33 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 30 of 33 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 1 29 19 All staff must have a full 31/05/2009 enhanced CRB disclosure conducted before they start working at the home, unless in exceptional circumstances, when detailed records need to be retained. This is to consistently protect all the people living at the home. 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 2 3 7 8 16 All those living at the home or their relative should be given the opportunity to be involved in the planning of their care. All risk assessments should indicate what action is required as a result of an identified potential risk. It is recommended that action taken to address complaints received should be recorded alongside the outcome of the homes investigation. The paintwork in areas was in need of freshening up as Page 31 of 33 4 19 Care Homes for Older People 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 described in the body of this report and the corridor carpet on the first floor should be replaced so that this area of the home matched the standard of the rest of Bank House. 5 27 The home should conduct an audit of the calculated staffing levels used by the home to ensure that everyones assessed needs are being fully met. The home should continue working toward the recommended 50 of care staff having achieved a recognised qualification in care, so that enough care staff are appropriately qualified to deliver the care required and to oversee the support provided by unqualified care staff. All references should be dated. If the referee omits the date on which the reference is written then it is recommended that the home records the date on which the reference is received. It is recommended that surveys now be conducted for people working at the home so that they can give feedback about what it is like working at Bank House. Stakeholders in the community should also be given the opportunity to give their views about how the home is meeting goals for those using the service. It is recommended that once a plan of action has been drawn up to address the items raised by the fire officer, then a copy should be forwarded to the Care Quality Commission showing how the issues are to be addressed. It is recommended that the risk assessments in relation to safe working practices as well as the policies and procedures of the home be dated and reviewed at more regular intervals so that staff are provided with up to date guidance. 6 28 7 29 8 33 9 38 10 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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