Care Home: Bedford Residential Nursing Care Home

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What the care home does well Before residents went into the home, one of the senior members of staff visited them in their own homes or in hospital to make sure that the care they needed could be provided by the home. The qualified nurses and care staff were very good at caring for the residents who were very ill and needed lots of specialised care.The nurses and senior care staff make sure that they continually look at anything that may be a risk to the residents. They then make sure that they write down in the resident`s care plan when they have done this, and what action they have taken to reduce the risk. People visiting the home are made welcome and can visit at any time. The staff teams worked well together and good systems were in place for sharing information about residents. Comments were made to the inspectors such as: "The staff are very friendly and helpful", "I am well cared for" and "I am happy enough". The BUPA Company has a commitment to ongoing staff training and learning and has provided the care team with the knowledge and skills they need to protect and meet the needs of the residents. What has improved since the last inspection? The manager has done what we asked them to do at the last inspection. This includes fitting locks to toilet and bathroom doors to ensure privacy, providing extra staff to help out at busy times and improving the way records are kept relating to medicines taken by people living at the home. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Bedford Residential Nursing Care Home Battersby Street Leigh Lancashire WN7 2AH Lead Inspector Rukhsana Yates Unannounced Inspection 17 January & 1 February 2008 09:30 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 Bedford Residential Nursing Care Home DS0000005673.V337512.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. Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bedford Residential Nursing Care Home Address Battersby Street Leigh Lancashire WN7 2AH 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) 01942 262202 01942 605901 atkinsos@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd Mrs Susan Atkinson Care Home 180 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (60), Old age, not falling within any other of places category (180), Physical disability (8) Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the maximum registered number 180, there can be:BEECH HOUSE - up to 30 service users in the category DE(E) (Dementia over 65 years of age) to include 5 service users in the category DE (Dementia between 55 - 65 years of age) PENNINGTON HOUSE - up to 30 service users in the category DE(E) (Dementia over 65 years of age) to include 5 service users in the category DE (Dementia age between 55 - 65 years of age) KENYON HOUSE - up to 30 service users in the category OP (Older People over 65 years of age) for nursing care; to include up to 2 service users in the category PD (Physical Disability, but between the ages of 55 - 65 years of age) CROFT HOUSE - up to 30 service users in the category OP (Older People over 65 years of age), for nursing care; to include up to 2 service users in the category PD (Physical Disability for nursing care) between the ages of 55 - 65 years of age LILFORD UNIT - up to 30 service users in the category OP (Older People over 65 years of age) to include up to 2 service users in the category PD (Physical Disability) between the ages of 55 - 65 years of age ASTLEY UNIT - up to 30 service users in the category OP (Older People over 65 years of age) for personal care, to include up to 2 service users in the category of PD (Physical Disability) between the ages of 55 - 65 years of age.) The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 17th October 2006 2. Date of last inspection Brief Description of the Service: Bedford Nursing and Residential home is situated on the outskirts of Leigh town centre, close to shops and other amenities, and is close to the main bus route. Bedford consists of six separate units each providing care to meet the differing needs of the residents. Two houses are registered to provide nursing care, two provide social care and two houses provide nursing care for people with dementia. The personal accommodation is provided in single rooms with a large communal lounge and dining room. There is access to garden and patio areas. There is ample car parking at the front of the home. Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 5 The weekly fees for the service range from £462.50 to £650, depending on the level of care required. Additional charges are made for hairdressing and newspapers. More information is available from the home and the statement of purpose and brochure are provided on request. Bedford Residential Nursing Care Home DS0000005673.V337512.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. As part of the inspection process, the home was visited over the course of four days, with one visit taking place during the weekend. Nobody was told of the visits beforehand. Before the inspection, the manager completed a form called an Annual Quality Assurance Assessment. This provided some basic information about what the service considered it did well, and what needed to improve. Surveys were sent out to the residents, their relatives and to the home itself. These surveys asked what people thought of the quality of the service and the facilities provided. During the visits we looked at care and medicine records to ensure that the health and care needs of the residents were being met. We looked around the building at the bedrooms, bathrooms toilets and sitting areas on each unit to check if they were clean and well decorated. We visited residents in their own bedrooms and lounge areas. This was to check out the care that was being provided for them. We also looked at what the residents had for their lunch and evening meal, how many staff were provided on each shift to make sure the residents’ needs were being met and how management recruit and train their staff. How the home manages the residents’ spending money was also looked into. To make sure that the home and the equipment in it were safe, some of the maintenance and service records were looked at. In order to get further information about the home, we spent time speaking to ten residents, nine relatives, three qualified nurses, two care assistants and the management team. What the service does well: Before residents went into the home, one of the senior members of staff visited them in their own homes or in hospital to make sure that the care they needed could be provided by the home. The qualified nurses and care staff were very good at caring for the residents who were very ill and needed lots of specialised care. Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 7 The nurses and senior care staff make sure that they continually look at anything that may be a risk to the residents. They then make sure that they write down in the resident’s care plan when they have done this, and what action they have taken to reduce the risk. People visiting the home are made welcome and can visit at any time. The staff teams worked well together and good systems were in place for sharing information about residents. Comments were made to the inspectors such as: “The staff are very friendly and helpful”, “I am well cared for” and “I am happy enough”. The BUPA Company has a commitment to ongoing staff training and learning and has provided the care team with the knowledge and skills they need to protect and meet the needs of the residents. What has improved since the last inspection? 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. Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 8 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 Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 9 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): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People are given information about the service, and assured that their needs can be met before admission takes place. EVIDENCE: The home has a brochure pack that includes a service users’ guide. This is made available to current and prospective residents. The contents were discussed with the manager in respect of making the information easier to read by using plain English and large print, for example, so that people can readily understand the contents. Before being admitted to the home, people had undergone a formal preadmission assessment, conducted by the home manager or care manager. Pre-admission assessments were detailed and used to ensure that the home is suitable for prospective residents and able to meet their particular needs appropriately. Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 10 The formal assessment conducted by the home was also supplemented by assessments conducted by other health and social care professionals, including psychiatrists and social workers. The information gained from all the assessments was used to develop a plan of care following admission. Some people were unable, due to their particular illnesses, to comment on their experience before and during admission to the home. However, a number of relatives stated that they felt they were fully involved and consulted throughout the whole assessment and admission process. The assessment documentation of two people most recently admitted contained personal details, past medical/mental health history. Assessments also included details of personal care, well being, diet, dietary preferences, sight, communication, oral care, foot care, mobility, dexterity, history of falls, continence, mental state, social interests, hobbies, carers, family and personal safety. The relative of one person said “I came and had a look around. I have always been made to feel welcome”. New assessment documentation has been increasingly used since the last inspection. This has helped staff to consider a wider range of areas when assessing and reassessing needs, but the sections relating to “service user perspective” were not completed in most of the care plans seen. This should be addressed to show that people have been consulted about their care needs and how they would like them to be met. Standard 6 does not apply. The home does not provide Intermediate Care. Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 11 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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The quality of care plan recording is being improved to better reflect the support needs of the residents, and ensure their health and social care needs are met. EVIDENCE: Care records are organised in a standard format throughout the home. Three care plans were examined on each of the units. All contained pre and post admission assessments that identified the care needs of residents. The care plans seen varied in the quality and quantity of information they contained and two of the plans had inconsistent risk assessment information and had not been reviewed monthly. Staff members were working hard to understand and use the new assessment documentation and the manager was aware that further training was required for some staff so that the new format would be used to fully and effectively monitor the care being delivered. Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 12 The areas covered in care plans included managing risk, communication and lifestyle, environment, mental state and cognition, breathing, eating and drinking, cleansing, dressing, maintaining body temperature, sleeping and end of life arrangements. The majority of plans had been reviewed monthly. Examples of risk assessments included those relating to preventing pressure sores, mobility, moving and handling and nutrition (including regular weight monitoring). All residents were registered with a local GP and it was evident that all were enabled to access opticians, chiropodists, district nurses and other specialist services required, such as community psychiatric nurses and psychiatrists. Relatives said they were kept informed of all significant changes in their relation’s health and were happy that people were enabled to attend appointments away from the home, for example, at hospital outpatients departments. From the care plans inspected it was evident that the residents were weighed at least on a monthly basis and action taken if any weight loss had occurred. A discussion with the residents and relatives identified that the residents had access to other health care services, including hearing, sight tests and a visiting chiropodist. Evidence of these visits was kept in the residents’ individual files. Equipment necessary for the prevention and treatment of pressure sores was available on all the units. The systems for the receipt, recording, storage, handling, administration and disposal of residents’ medicines were appropriate and safe. The qualified nurses are responsible for all aspects of looking after residents’ medicines in the home. Medicine records had been completed properly. Medication requiring refrigeration was stored within dedicated medication refrigerators. Records of medicines received into and leaving the home were maintained. The medication fridge temperatures were recorded at least daily. Staff responsible for the administration of medication had undertaken training. Discussion with relatives and staff revealed that residents were treated with respect and that their right to privacy was upheld. Comments made included; ‘the staff are friendly and caring. I am well looked after” and “They treat me properly”. Discussion with staff indicated that they received appropriate training and support to meet the health and personal care needs of residents. The staff were seen to deal with the residents in a friendly, comfortable and respectful way. Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 13 On the whole, staff were seen to be discreet when providing assistance. One instance was observed where staff members were not discreet when asking residents if they wanted to use the toilet, and this was raised with the manager. An assurance was given that this would be addressed. Staff demonstrated a promotion of privacy and dignity by knocking on doors, closing toilet doors, etc. Residents were able to comment indicated that staff treated them with respect and maintained their privacy. For example, one resident said he liked to spend time most of the day in his room and this was all right. This resident’s care plan also reflected this preference. Some residents said that they did not know how to call for assistance when in their rooms. On examination, it was found that some nurse call units did not have a lead or the unit was out of reach if the resident was in bed. This compromised the ability of residents to request and obtain assistance when needed. A requirement has been made with regard to this under the section relating to the environment. Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 14 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, 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People are supported to exercise as much personal freedom and choice as possible. The meals at the home offer choice and variety. EVIDENCE: Hobby therapists are employed at the home to help to ensure that people are provided with a suitable stimulating programme of leisure and social activities that they can participate in, if they wish. Timetables of activities were displayed, and the units equipped with a wide variety of suitable games, books, arts and crafts and other recreational equipment. The leisure and social activities programme also included trips out into both the local community and places of interest, and a number of photographic collages documenting these outings were displayed in one of the units. Entertainers periodically visit the home and themed events are held at regular intervals – for example, at Halloween, Christmas and Easter. Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 15 Outside the bedrooms of people with dementia, ‘memory boxes’ are in place that contain small personal items and photographs that are personal to that particular resident. This development, along with activities that concentrate on residents’ abilities to reminisce are important in helping residents in their daily lives. Residents spoken to said that they were satisfied with the way they were allowed to spend their day, more or less as they pleased. The residents’ routines of daily living and their social interests were recorded in their care plans. The staff described how they assisted residents with choices, such as choosing clothing and food, etc. Relatives confirmed that there were no unreasonable restrictions to them visiting their relation at the home and that visits could be conducted in the privacy of the resident’s room or quieter areas of the home. Examination of visitor’s books on all units showed evidence of people visiting at various times of the day. Visitors spoken with indicated that the staff made them feel welcome when visiting. Staff were seen offering visitors refreshments and also took time to speak to them. Residents are encouraged to bring personal possessions into the home. Many of their bedrooms were highly personalised, with small pieces of their own furniture, pictures, photographs and ornaments. The general view was that meals were of a reasonably good quality. Meal times are reasonable and residents were served and assisted with their lunch appropriately on the day of inspection. Menus are balanced, varied and provide choice. Residents’ likes and dislikes are established directly and through discussion with residents’ relatives. The residents have a lighter lunch and a more substantial meal in the evening. Residents can have a cooked breakfast every morning and staff told us that residents have a supper that includes a milky drink if they wish. Menus were displayed in a frame in small print on all of the units. The day’s menu should be displayed in a format that can be easily seen by residents, so that they know what the meal choices are for each day. Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 16 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People feel that their views are listened to. Staff knowledge and understanding of safeguarding policies reduces the possible risk of harm or abuse to people living at the home. EVIDENCE: A detailed complaints procedure was in place and was displayed in the reception area. A discussion with residents and relatives indicated that there was a general awareness of how to make a complaint. Replies from the comment cards showed that the residents knew how to make a complaint if they had to. It was clear in discussion with staff that they also knew what steps to take should a resident make a complaint; but, in some instances, were not recording minor complaints and the action they had taken. All complaints should be recorded so that the information can be analysed as part of the quality assurance system. Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 17 None of the residents or visitors spoken with had made a complaint. There have been three complaints made to the home since the last inspection. These have been properly dealt with. One complaint was being investigated by relevant agencies at the time of this visit, and an independent advocate involved. The Service User Guide that is given out to all residents/families also explained the complaints procedure. A policy and procedure was in place in relation to the detection of abuse and neglect (including whistle-blowing) and how to respond to suspected abuse. The home had a copy of the Local Authority’s procedure for protection of vulnerable adults. Since the last inspection, almost all of the staff have received training in abuse awareness and staff spoken to were very clear about what to do if an allegation of abuse had been made. Training in this area is an ongoing process and further training sessions have been planned for the future. Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 18 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 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Although the residents were living in a clean and safe home, in parts it was in need of redecoration and refurbishment. EVIDENCE: There is level access to the front of the home and to each unit. All the houses provide ground floor, bungalow style accommodation. This allows easy access for wheelchair users and people who have problems climbing steps. There is plenty of parking to the front of the home. Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 19 Communal lounge and dining areas were clean, suitably heated, comfortably and appropriately furnished, although some armchairs were torn and in need of replacement. Appropriate provision of televisions, music centres and other leisure equipment has been made. Residents are also enabled to access the pleasant, secure and substantial garden areas adjacent to both houses when the weather permits. The home has generally been suitably adapted to meet the needs of residents in relation to specialist equipment. Individual residents’ specialist needs are met following referral to the relevant health care professional. Residents’ bedrooms that were inspected were clean, suitably furnished and equipped and, in many cases, very personalised. However, some rooms were sparse and, in one instance, some of the bedding was torn. All bedrooms are provided with fitted wardrobes and a washbasin. Since the last inspection, soap dispensers and paper towels have been provided in bedrooms for staff to wash their hands and improve infection control. The rooms were individually and naturally ventilated and radiators were suitably protected. Several bedrooms had nurse call units that were out of reach for residents when they were in bed, or did not have a lead attached. All residents must have access to the nurse call, if able to use it safely, so that they can call for assistance any time they need to. Storerooms and sluice areas are provided for storing equipment and cleaning materials and these areas were securely locked at the time of this inspection. Each unit had assisted bathing facilities and the toilets had aids to assist any resident with a disability or mobility problems. Emergency lighting is provided throughout the home and the lighting in resident areas was domestic in character. The laundry was clean well equipped and appeared to be well organised. Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 20 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People’s basic care needs are being met by the numbers of staff on duty. Staff members have the knowledge and skills to meet people’s needs. EVIDENCE: Inspection of staffing rotas provided by the home indicated that staffing levels were appropriate to meet the basic care needs of the residents. Visitors spoken with said that staff cared for residents well but were always very busy. Since the last inspection, arrangements have been made to have additional staff on duty, who can work where needed at busy times. Night time staffing levels are currently being reviewed by the manager to ensure that they are adequate in meeting people’s needs. Staff spoken with indicated that the dependency levels of residents were now much higher than a few years ago. They felt that teamwork at the home was good, and that communication between staff members was effective in ensuring continuity of care for residents. There were several male residents living at Bedford House and also several male carers and nurses. This gave the residents, at times, a choice of whom they wished to care for them. Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 21 The personnel files of three staff members were inspected. All were in order and these staff had been properly and safely employed. They had a completed application form, two professional references, an enhanced criminal records disclosure (CRB) check and a health status declaration. A detailed induction-training programme was in place. This was in accordance with the Skills for Care Induction Standards. Each staff member is provided with a very detailed induction/training portfolio. All members of staff receive induction training within six weeks of appointment to their post and further training within the first six months of appointment. Training records were in place. These showed training had been undertaken in areas that included Moving and Handling, Fire Safety, First Aid, Food Hygiene, Infection Control, Health and Safety, Medication Management and nutrition. A few staff members require training in the Protection of Vulnerable Adults, but this was in the process of being addressed. Staff spoken with on all units said sufficient training was provided. Over 50 of the care staff have achieved their NVQ at level 2 or above. Staff receive formal supervision six times a year. Supervision records showed that these meetings should be used to assist staff with their learning and reflect on practice. For example, some staff members needed assistance to better complete the information in care plans relating to social needs and how to meet them. Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 22 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, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The manager provides effective leadership and support, and is aware of areas to be improved upon which would benefit people living at the home. EVIDENCE: The manager is a Registered General Nurse who has extensive experience in care of the elderly both in the NHS and the private sector. She has been working for BUPA for over ten years and has been at Bedford Care Home for five and a half years. She has obtained the Registered Manager’s Award. There was evidence to show that she has undertaken periodic training to update her knowledge, skills and competence. Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 23 BUPA has its own Quality Assurance division and internal audits are undertaken on a regular basis. Management make sure that checks are undertaken on all areas of the home in relation to health and safety and fire issues. Regular checks are also undertaken of care plans, the incidence of any pressure sores, medications, the kitchen, accidents, incidents and anything else that affects the safety and well-being of the residents and staff. Questionnaires have been developed and given out to residents and relatives. The system for the safekeeping of residents’ finances was good. The management of residents’ finances are generally undertaken by their families or designated representative. Generally, only personal allowances are held by the home in a residents’ account. Individual computer records are made of all transactions and balances. Receipts are held for any purchases made and receipts are given to relatives when they deposit any “spending money” for their relative. The home had a detailed Health & Safety Policy. Regular weekly checking and testing of fire detection system, fire exits and emergency lights was undertaken and documented. Any accidents that happen are properly recorded and monitored. Records showed that the equipment and services within the home were serviced on a regular basis in accordance with the individual requirements. Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 24 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 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 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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 OP19 Regulation 23(2) Requirement Nurse call facilities must be accessible to people in their rooms at all times so that they can call for assistance when needed. Timescale for action 30/03/08 Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP1 OP7 Good Practice Recommendations The service user guide should be made available in different formats so that they are easy to read and understand. The views of people living at the home regarding their care should be included in plans, to show that people have been consulted about their care needs and how they would like them to be met. The day’s menu should be displayed in a format that can be easily seen by residents so that they know what the meal choices are for each day. Minor complaints reported to staff on individual units should be recorded so that the information can be analysed and used to improve the quality of the service. Regular environmental audits should take place to ensure that each person’s bedroom is suitably furnished and personalised as agreed with the resident. Meetings between staff and managers should be used to help staff develop and improve their practice, and this should be reflected in records of supervision. 3 4 5 6 OP15 OP16 OP19 OP30 Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Manchester Local office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Bedford Residential Nursing Care Home DS0000005673.V337512.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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