Care Home: Bedwardine House

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What the care home does well A warm welcome is given to visitors, and the atmosphere is relaxed and friendly. Everyone who was spoken to said they were comfortable and happy to be living at the home. Relevant information about the service, and what can be provided, is available to assist prospective residents and their families to make the right decisions about their future care needs. Residents confirmed that they are involved in making decisions about their daily lives, with support from staff to do as they wish, that they are treated with respect and consideration at all times, and that their privacy and dignity is observed. There is a commitment from the staff team to providing good care, and comments from residents confirmed that this is achieved, and that they are satisfied with the care received. A high standard of personal care is provided for each resident at the home, and the staff work well with other professionals and agencies, to help improve and maintain the health of residents. Opportunities are available for everyone living at the home to do the things they enjoy, and they are able to choose, if they wish, to be involved in the many activities that are provided. The involvement of friends and relatives at the home is actively encouraged, and everyone with whom the inspector spoke were very positive about the home and the service provided. The arrangements regarding the provision of food reflect the individual preferences of each person, and the provision of a nutritious and wholesome diet is helpful in maintaining their health and wellbeing. A satisfactory complaints procedure has been produced and is implemented at the home, in a clear and open manner. A record is also kept of compliments made about the home, although all comments should be recorded, to give a balanced view of the service that is being provided. The building is maintained to a high standard, and everywhere is fresh and clean. The house gives the appearance of being well cared for, and it is nicely furnished, warm and comfortable, and safe and secure. A pleasing environment is maintained both within and outside the home. The National Vocational Qualification (NVQ) training programme is in place at the home, and additional care related training is also provided for staff, which should enable them to provide a good standard of care for residents. The positive interactions between staff and residents are pleasing to observe, and the home very obviously revolves around the people who live there. The commitment of staff to maintaining high standards is commendable. The quality of the service provided at the home is checked to make sure that the home achieves what it says it will for the people who live there, and to enable them to say how they would like the service to develop. What has improved since the last inspection? The management have responded to the requirements and recommendations made at the last inspection, and procedures have been further developed and documentation reviewed. A more detailed and thorough assessment is now undertaken prior to a prospective resident being admitted, which helps to determine if the needs of the person can be met at the home. Care planning and risk assessment procedures have been developed, and documentation improved, which has helped staff to better understand the needs of residents. Person centred care is also being developed, so that the care provided revolves round the people who live there. The procedures relating to the administration of medication are satisfactory, and the training provided for staff helps to ensure that residents are protected, but further review will be needed to reflect the proposed extension of the home. The review undertaken of the policies and procedures relating to the protection of vulnerable adults from abuse, and the training provided for staff will help to ensure that the people living at the home are safeguarded. The ongoing upgrading and maintenance of the premises has enhanced the facilities available to the people who live and work at the home, and the proposals for future developments should further improve their quality of life. Recruitment and selection procedures are being implemented more rigorously, and appropriate information obtained prior to appointing staff, which will ensure that residents are better protected. The reviews that are undertaken of the documentation at the home will help to ensure the safety and protection of the people who live at the home. What the care home could do better: The development of a more person centred approach to the provision of care will ensure that the care provided revolves round the people who live there. The use of advocacy services for a resident without any immediate family should be considered, to ensure that any decisions that need to made are in the best interests of the resident. The complaints procedure enables any concerns to be expressed, but a record of all the comments and compliments made about the home will help to give a more balanced view of the service that is provided. Further training for some staff so that they fully understand all the issues relating to abuse and the protection of vulnerable people, will ensure that everyone living at the home is safeguarded. The proposed upgrading and extension to the premises, and the development of the service should enhance facilities and improve the quality of life for the people living at the home. The management will need to keep staffing levels under review, to reflect the increase in the number of residents, and also to ensure that people living at the home, who may have specific needs, receive appropriate care. The further development of quality monitoring will help to produce the best possible outcomes for service users, and to measure how well the aims and objectives of the home are being met. The management of the home continue to acknowledge the areas where performance can be improved, and they constantly strive to achieve and exceed the required standards. CARE HOMES FOR OLDER PEOPLE Bedwardine House Upper Wick Lane Rushwick Worcestershire WR2 5SU Lead Inspector Rachel McGorman DRAFT Unannounced Inspection 31st October & 6th November 2007 10:30 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 Bedwardine House DS0000018631.V341471.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. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bedwardine House Address Upper Wick Lane Rushwick Worcestershire WR2 5SU 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) 01905 425101 01905 749723 Mrs Victoria Lavender Mrs Victoria Lavender Care Home 17 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (17), of places Physical disability over 65 years of age (17) Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th November 2006 Brief Description of the Service: Bedwardine House is registered to provide personal care for up to 17 older people who are frail and who may also have a physical disability. Eight places are also registered for older people who have a dementia illness. The property is a large, detached, Georgian building, located in a semi-rural position, and set in extensive grounds on the outskirts of Worcester, with pleasant views over the surrounding countryside. The home has an attractive front garden, there is ramped access to both the front and rear of the premises, and there are ample parking facilities. The fees range from £346.00 to £390.00 per week. The home is owned and run by Mrs Victoria Lavender who is the Registered Care Manager and also the Registered Provider. She is also assisted in the dayto-day running of the home by her husband and her daughter. The stated aims and objectives of the service are to provide residents with a secure, relaxed and homely environment, in which their care, wellbeing and comfort are of prime importance. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of this routine key inspection, was to monitor the care provided at the home, to assess how well the service meets the needs of the people who live there, in relation to the stated aims and objectives, and to follow up previous requirements and recommendations. Preparation for the inspection included viewing previous reports, and documents relating to the home, and considering the various contacts made with the home since the last inspection. Two unannounced visits were also made to the home, taking approximately 6 hours in total. The Annual Quality Assurance Assessment (AQAA) for the service, has been completed and submitted to the Commission, and also informs this report. Discussions were held with the registered manager, Mrs Victoria Lavender about her role, and the management of the home. The inspector also spoke with the senior carer, about care practices and the administration of medication. Relatives, and visitors to the home at the time of the inspection, were asked for their views of the service and the care that is provided, and surveys were circulated to five people. Time was spent with several residents, discussing with them what it is like to live at the home, and observing their interactions with staff. The care records of two residents were checked in detail for case tracking purposes. During conversations with staff, comments were made about their experience of working at the home, and several staff files were also seen, in relation to recruitment practices, and to confirm the training and supervision provided. The records were checked during the course of the inspection, including those required for the protection of residents, those relating to the business and to care practices, to the servicing of equipment, and to health and safety matters. The Medication Administration Records were also seen. A tour of the premises was undertaken, and the ongoing maintenance, various improvements that have been made, and the future proposals for the development of the home were also discussed with the management. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 6 What the service does well: A warm welcome is given to visitors, and the atmosphere is relaxed and friendly. Everyone who was spoken to said they were comfortable and happy to be living at the home. Relevant information about the service, and what can be provided, is available to assist prospective residents and their families to make the right decisions about their future care needs. Residents confirmed that they are involved in making decisions about their daily lives, with support from staff to do as they wish, that they are treated with respect and consideration at all times, and that their privacy and dignity is observed. There is a commitment from the staff team to providing good care, and comments from residents confirmed that this is achieved, and that they are satisfied with the care received. A high standard of personal care is provided for each resident at the home, and the staff work well with other professionals and agencies, to help improve and maintain the health of residents. Opportunities are available for everyone living at the home to do the things they enjoy, and they are able to choose, if they wish, to be involved in the many activities that are provided. The involvement of friends and relatives at the home is actively encouraged, and everyone with whom the inspector spoke were very positive about the home and the service provided. The arrangements regarding the provision of food reflect the individual preferences of each person, and the provision of a nutritious and wholesome diet is helpful in maintaining their health and wellbeing. A satisfactory complaints procedure has been produced and is implemented at the home, in a clear and open manner. A record is also kept of compliments made about the home, although all comments should be recorded, to give a balanced view of the service that is being provided. The building is maintained to a high standard, and everywhere is fresh and clean. The house gives the appearance of being well cared for, and it is nicely furnished, warm and comfortable, and safe and secure. A pleasing environment is maintained both within and outside the home. The National Vocational Qualification (NVQ) training programme is in place at the home, and additional care related training is also provided for staff, which should enable them to provide a good standard of care for residents. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 7 The positive interactions between staff and residents are pleasing to observe, and the home very obviously revolves around the people who live there. The commitment of staff to maintaining high standards is commendable. The quality of the service provided at the home is checked to make sure that the home achieves what it says it will for the people who live there, and to enable them to say how they would like the service to develop. What has improved since the last inspection? The management have responded to the requirements and recommendations made at the last inspection, and procedures have been further developed and documentation reviewed. A more detailed and thorough assessment is now undertaken prior to a prospective resident being admitted, which helps to determine if the needs of the person can be met at the home. Care planning and risk assessment procedures have been developed, and documentation improved, which has helped staff to better understand the needs of residents. Person centred care is also being developed, so that the care provided revolves round the people who live there. The procedures relating to the administration of medication are satisfactory, and the training provided for staff helps to ensure that residents are protected, but further review will be needed to reflect the proposed extension of the home. The review undertaken of the policies and procedures relating to the protection of vulnerable adults from abuse, and the training provided for staff will help to ensure that the people living at the home are safeguarded. The ongoing upgrading and maintenance of the premises has enhanced the facilities available to the people who live and work at the home, and the proposals for future developments should further improve their quality of life. Recruitment and selection procedures are being implemented more rigorously, and appropriate information obtained prior to appointing staff, which will ensure that residents are better protected. The reviews that are undertaken of the documentation at the home will help to ensure the safety and protection of the people who live at the home. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 8 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 Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 9 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3 & 5 People who use the 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 information available to prospective residents, and the way in which the admission procedure is implemented, provide an appropriate introduction to the home, and also help people to make an informed decision about their future care needs. The pre-admission assessment provides relevant information about the prospective resident, and ensures that the home is able to meet their identified personal and healthcare needs. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 12 EVIDENCE: The Statement of Purpose and Service Users Guide have been reviewed to more accurately reflect the care that can be provided at the home. These documents will enable prospective residents and their family or representative to decide if the home is likely to be suitable for them. A written statement of the Terms and Conditions of Residence is provided on admission, and contains information for the resident about their occupancy in the home. The document reflects the rights and responsibilities of both the resident and the management, and there is an expectation that both parties will sign to confirm acceptance. Residents confirmed that they had been provided with a copy of each of the documents, and a signed receipt was also held on file. A satisfactory admission procedure is in place at the home. The Care Manager undertakes a pre admission assessment for all prospective residents, either at home or in hospital, following the initial referral, to ensure that the home will be able to provide appropriate care. The assessment forms in the files of residents contain information that enables staff to decide if the needs of prospective residents can be met at the home, and discussions with staff and residents, confirmed that, ‘the appropriate procedures are followed, that their needs are being met, and that they are living at the home because this is their wish’. A visit to Bedwardine House is encouraged, and prospective residents are invited to spend time with the people already living at the home, and to have a meal with them. Arrangements may also be made for a short stay, if this is preferable, prior to the final decision being made about living at the home. The first four weeks following admission are considered to be a trial period, during which time the resident is able to decide if they are likely to be happy living at the home, and also the staff are able to further assess if they can meet their needs. In addition, a Community Care Assessment is provided by the placing authority, prior to admission, for people who are not self-funding. Residents and their relatives spoken with at the home, and also responses in the surveys confirmed that, ‘they had enough information before deciding to live there’, that ‘they were able to visit the home and meet everyone first ’, and ‘had been made to feel welcome’. One person was able ‘to have a short stay for a while, before deciding to move in permanently’. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the 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 individual plan of care is based on the initial assessment of the resident, which identifies their needs, and provides evidence that their personal and healthcare needs are being met. Risk assessments are completed, to support service users in being as independent as possible. The policy and procedures covering the administration of medication ensure the protection of service users. Staff have a good understanding of the needs of residents, and offer care in a way that encourages and promotes their independence. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 14 EVIDENCE: A plan of care is produced for each resident based on the initial assessment undertaken prior to admission. The individual care plans of two residents were viewed, and both contained appropriate information on their needs, and how these were to be met. The care plans are being reviewed every month, and there is evidence of further progess, with a more person centred approach being introduced. A comprehensive assessment form is used as the basis of the care plan, that covers all aspects of the life of the resident, and includes daily living needs, health and personal care, physical well-being, social interests and relationships, religious and cultural needs and any additional areas specific to individual residents. The involvement of residents in determining their care was evident, and several people confirmed when talking with the inspector, that their care needs are discussed with them and their family. Comments made to the inspector were all positive about the wonderful care provided, and the kindness and commitment of staff. Risk assessments are completed in relation to mobility, moving and handling, tissue viability, and nutritional, needs. The weight of residents is also closely monitored. A risk assessment for the use of bedrails for two residents is now in place, and the use of wheelchairs is also risk assessed and monitored regularly. All staff have been instructed that the footrests must always be used for the comfort and safety of residents. The inspector would wish to acknowledge the progress that has been made in regard to the development of care planning, and in implementing further the procedures relating to risk assessment, with obvious benefit to all the residents living at the home. The health and personal care needs of residents are monitored and the home is well supported by the Primary Health Care Team. Appropriate treatment can be accessed, and the advice of specialist nurses is sought when necessary, including the Community Psychiatric Nurses, the nurses who deal with Parkinsons disease, and the continence adviser. The chiropodist visits every six to eight weeks, the optician comes when requested, and dental care is arranged when required. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 15 The Medication Administration Records were seen, and the charts had been completed to a satisfactory standard. Staff were observed when administering medication to service users, and the correct procedures were being followed. The care manager said that accredited training had been provided for staff on the administration of medication, and also confirmed that the medication policy and procedure have been amended, information on the side effects of medicines is now available for reference, the number of tablets given is now recorded on the MAR sheet, and any handwritten instructions are signed for by two members of staff. A metal safe has also been provided for the storage and safe keeping of drugs. A further review of the process is planned on completion of the proposed building work, to ensure that the safety and protection of residents is promoted. A resident became quite distressed during a visit to the home, and the inspector was able to observe the very professional way in which the staff dealt with the situation. The advice of the GP and CPN was sought immediately, and the deputy explained that following a recent visit to the consultant, there had been a medication change, which had affected the resident quite adversely. A request to revert to the previous medication regime was being considered, and should therefore improve the quality of life for the resident once again. Further evidence to indicate that people are treated with dignity and respect was observed in the interactions of staff with residents, and was also confirmed in discussions with them. One resident stated, ‘the staff are always very helpful and kind’, another person said, ‘I feel very supported by the staff’, and one lady said, ‘I wouldn’t change anything, everything here is wonderful’. In addition, the following comments were made during the course of the visit, and also in the surveys that were circulated to residents and their relatives: • • • • • • • • • • I am very satisfied with everything I am looked after very well Staff are busy, but they are always there when I need them I’m really very content living here I am quite independent, but I’m very happy here I feel really well cared for by everyone The staff are excellent I have complete freedom to do just what I want I couldn’t wish for anything more I am made to feel very much at home Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the 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 wishes and preferences of residents are respected. They are encouraged to make choices about all the activities of daily living, and to have as much control over their lives as they are able. The social, emotional and spiritual needs of residents are identified, and various recreational opportunities provided to ensure their interests are fulfilled. The people who live at the home have complete freedom in regard to their contacts, both within and outside the home, which enables a good quality of life to be maintained, although advocacy services may need to be involved to ensure that the interests of all residents are protected. Residents are offered a choice of nutritious, wholesome and well-balanced meals that helps in maintaining their health and wellbeing. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 17 EVIDENCE: Residents at Bedwardine House have freedom of choice in regard to their contacts, both within and outside the home, and they are enabled to make choices with regard to all the activities of daily living, how to spend their day, and whether or not to join in the various pastimes. This was confirmed in conversation with people living at the home, the staff, and also in comments made by visitors. One lady said, ‘I can do just as I wish. I enjoy company, but I love to spend time in my own room as well’. One relative was very pleased about, ‘the way her mother has improved since being at the home’, and thinks, ‘it’s a lovely place’. She visits regularly, and is, ‘very satisfied with everything’. She is, ‘made very welcome’, and said that, ‘it’s a happy place, with lots of music and there is always something going on’. Organised activities are available, although some people prefer to stay quietly in their own room. The garden is a large and very pleasant place to take a walk or just to sit, or play bowls and croquet in the summer, and a number of people mentioned how much they liked to spend time there. During the afternoon, several residents were having a little wander around the grounds. A sample programme of activities is provided in the Statement of Purpose, and a weekly list can be found on the notice board. Two teams of residents were seen competing loudly in a game of basketball in the lounge, and they appeared to be enjoying every minute of it. The range of activities on offer are said to take into account peoples interests, skills and experience, and also to encourage them to maintain their interests. They include: craft work and painting or drawing, movement to music, bingo, sing-along to the old time favourites, playing charades, board/card games and doing jigsaws, holding a quiz, or having a manicure session. A fashion parade is arranged from time to time, and seasonal celebrations are also organised. In addition, occasional trips are arranged for shopping, to visit a garden centre, to go to the local pub for lunch, or attend the theatre or to watch a play in the local Village Hall. The care manager explained that the spiritual needs of residents are also considered. The priest and a minister visit the home regularly, and a communion service is also held from time to time. Residents are enabled to attend the local church, if this is their wish. There is one person living in the home who is without any immediate family. The care manager confirmed that this will be reviewed with the resident, and the involvement of advocacy services sought, to ensure that appropriate decisions are made in the best interests of the resident and the home. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 18 The catering arrangements at the home are satisfactory, and comments about the meals were all very good. One resident said, ‘I am given an alternative if there is something on the menu that I don’t like’, and another person was very complimentary about the food stating, ‘it is absolutely excellent’. The inspector viewed the kitchen, which was clean and tidy, and spent some time talking to the cook, who has worked at the home for the past five years. She said that, ‘residents are regularly consulted about the meals, and a list of likes and dislikes is maintained. Special diets can be provided and any specific requests and favourite meals will be produced if possible’. Fresh fruit and vegetables are used, and residents generally prefer basic home cooking, although occasionally a new dish is presented. For example, a sweet and sour meal was introduced recently and was surprisingly, very popular. The cook confirmed that there are no outstanding requirements following a recent visit from the Environmental Health Officer. The home is implementing the ‘Safer Food, Better Business’ system, produced by the Food Standards Agency, which was developed to help compliance with the regulations relating to food management, and the Food Guard Award has also been achieved. Food hygiene training is provided for all staff who handle food. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A satisfactory complaints procedure is in place at the home and residents and their families are aware of how, and to whom they should complain, should the need arise. The policy and procedures in place at the home relating to abuse and the training for staff should, with some further development, enhance the protection of the people who live there. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 20 EVIDENCE: A satisfactory complaints procedure has been produced and is accessible to residents and their families, who confirmed that they were confident that any concerns raised with the management of the home, would be listened to and addressed in an appropriate way. People felt that their opinions were welcomed, and they confirmed that they knew the procedure to be followed if they wanted to air their views. There have been no complaints made to the Commission about the service, during the last twelve months. The complaints log was seen and none were recorded, also very few compliments were included in the log, although several positive remarks were made to the inspector, or included in the survey responses from residents and their families. One resident explained that, ‘she knew who to approach, but had never had the need to complain’, another person said, ‘there is no problem with anything here,’ and a further comment was, ‘ I cannot imagine what anyone could find here to complain about, as this place is as good as it could be’. The care manager was encouraged to record all the comments made about the home and the care provided, to give a more balanced view of the service. A satisfactory policy and procedure on adult protection at the home has been produced, and includes whistle blowing, managing violence and aggression, and the physical restraint of an individual, and these documents are now being reviewed annually and signed and dated to ensure the protection of everyone at the home. There was also evidence to show that staff had read the policies. Staff are given training on abuse awareness as part of their induction package, and this is also covered during NVQ training, to increase their understanding of the issues relating to the protection of vulnerable people. The care manager said she has undertaken further adult protection training, senior members of staff have also attended training sessions, and further training is planned. Discussions with several members of staff confirmed their understanding of the many aspects of abuse. A copy of the booklet ‘Reporting Abuse or Mistreatment of Vulnerable Adults – Guidance for Staff’ produced by the Worcestershire Vulnerable Adults Protection Committee, has been issued to all staff at the home. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 & 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a pleasant home that is clean and comfortable, attractively decorated and furnished, and in an environment that is safe and secure. The layout of the house provides adequate communal space for the needs of the people who live there. The premises are suitable for their purpose, and the ongoing maintenance and development of the facilities at the home, is continuing to improve the quality of life for the people who live and work there. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 22 EVIDENCE: Bedwardine House is a large, detached Georgian building, located in a semirural position, and set in extensive grounds on the outskirts of Worcester, with pleasant views over the surrounding countryside. The property is well maintained and provides a homely environment for seventeen older people. The communal areas of the house include two lounges, which are homely and comfortable, and a nicely furnished conservatory that provides a pleasant dining area. There are extensive grounds, mostly laid to garden, that can be accessed by residents quite easily and safely, as there is ramped access to both the front and rear of the house. Ample parking facilities are available. There are 15 single bedrooms and 1 shared room, none of which have en-suite facilities, although those seen had been decorated and furnished to a high standard, and were also nicely personalised by the people who live there. Several residents said how much they liked their own room, and confirmed that, ‘they had been involved with choosing the colour scheme’. Comments were also made about the cleanliness of the home and specifically the bed linen, ‘everything and everywhere is spotless’, one person said. Consideration has also been given to colour schemes and choice of decor for people who have dementia, the care manager said. A stair lift connects the ground and first floor of the house, to enable easier access for people who may have difficulty in climbing the stairs. The home lacks some essential facilities, specifically an office, a staff room and a passenger lift, but planning permission has been granted for further development, which will be commencing in the New Year and should be completed within six months. The proposals include provision of a staff changing room, an office, and a passenger lift, eight new en suite bedrooms, the addition of three further en suite facilities to bedrooms in the existing building, and two additional walk-in shower/wet rooms. There is now an ongoing programme of maintenance and upgrading for the home, and several recent improvements were noted, including, a new flat roof to the main building, replacement of bedroom furniture, fitting of new carpets, damp treatment and redecoration to some areas of the house, and the provision of soap dispensers and paper towels in proximity to wash basins, all of which have helped to improve facilities for the people who live and work at the home. The home is clean and fresh throughout and staff confirmed that they are familiar with the procedures regarding the control of infection, and that they have also been given training in health and safety matters. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are being maintained at an adequate level to meet the needs of the people who live at the home. Residents are now supported and protected by the recruitment and selection procedures that are followed by the management of the home. The commitment to NVQ training for staff together with a relevant training programme should ensure that each member of staff is competent, has a clear understanding of their role and is able to deliver the appropriate care for residents. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 24 EVIDENCE: The staff rotas were seen and the care manager considers that staffing levels are adequate for the needs of the people who live at the home, and this was confirmed in conversation with residents, who were very complimentary in their comments about the staff and the care they receive. There is a minimum of three care staff on duty throughout the waking day, and at night there is one member of staff on duty in the home, supported by the care manager who lives in the property at the rear of the house. Catering and domestic staff are also employed, and the husband of the manager takes responsibility for the maintenance of the home. The Registered Provider confirmed her intention to review staffing levels on completion of the new extension, with the subsequent increase in the number of people for whom care will be provided. The ratio of staff to residents will also be taken into consideration in relation to the proposal to develop further facilities for people who have a dementia illness. There are very few changes in the staff team working at the home, and there has been just one new member of staff appointed in the last twelve months. Several of the staff have worked at the home for many years. The files of two members of staff were inspected, and the correct procedures are being followed, in regard to recruitment and selection, which should ensure the safety and protection of the people who live at the home. Relevant information is recorded and appropriate documentation is in place, and includes evidence of Criminal Record Bureau (CRB) checks undertaken prior to employment, the applicants CV, two written references, a health check, proof of identity, a birth certificate, a photograph, a training profile and training certificates providing evidence of qualifications. The members of staff who spoke with the inspector, said that they enjoy their work, and they are very positive about their employment at the home. They appeared to be enthusiastic and well motivated, and confirmed that training is provided for them. They are also given the opportunity to express their opinions at staff meetings, and felt that consideration is given to their views. Various comments were made about, ‘being able to work in such a caring environment’, and one person said, ‘she wouldn’t change anything.’ Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 25 There is a commitment by the management of the home to the National Vocational Qualification (NVQ) training. Six members of staff have achieved the NVQ Level 2 in Care, which represents 50 of the care staff and two staff have the NVQ Level 3 in care. A record is maintained of the training undertaken at the home, and includes both statutory and care related courses, and the records show that training has been provided for staff in health and safety, basic first aid, fire safety, food hygiene, and moving and handling. In addition, some staff have attended care related training sessions on the administration of medication, dementia care, infection control, and abuse awareness. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 People who use the 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 service is focussed on the best interests of the people who live at the home, and the ongoing development of quality monitoring, and the more organised approach to the management of the home, has enabled the service to be more effective. The health, safety and welfare of service users and staff is promoted in respect of all safe working practices, to ensure that the people who live and work at the home are fully protected. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 27 EVIDENCE: Bedwardine House is owned and run by Mrs Victoria Lavender, who is the Registered Care Manager and also the Registered Provider. She is assisted by her husband in the daily running of the home, and her daughter is also employed as deputy manager. Mrs Lavender has many years experience in providing residential care for older people, and she has the Registered Managers Award in both management and care. The need for a formal system for measuring how well the home succeeds in achieving the stated aims and objectives, and for the results to be audited and published annually, has been identifed previously. The inspector would wish to acknowledge the extensive work that has been undertaken, and the progress that has been made, in developing a quality assurance system for the service. The results of Service User and also the Visitor Satisfaction Questionnaires are included in the Service Users Guide, and these covered the areas relating to service provision including the accommodation, housekeeping, personal care, catering arrangements, activities and staffing. The responses had been collated and a summary of the results had been produced in a clear format. The annual development plan for the home includes details of social activities available for service users, staff training and the proposed improvements to the accommodation, although further information about the outcomes for service users, would be of benefit. An Annual Quality Assurance Assessment (AQAA) has been completed and submitted to the Commission, and this document helps to show the way the home measures how well it meets the needs of the people who live there. The comments of a professional who had been requested to assess some aspects of the home provide a very positive overview of the service: ‘ I am impressed with the way the staff are able to assess and review individual needs, and also with the encouragement given to residents in maintaining their independence. The level of sensitivity and the care that is given is a delight to witness’. The management of the home confirmed that staff do not have any involvement with the financial affairs of residents. Arrangements are in place for the family or a representative to take responsibility, where a service user lacks capacity or does not wish to be involved. A small petty cash float is held for incidental purchases, and the records, which were viewed briefly, are maintained to a satisfactory standard. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 28 A procedure for the regular, formal supervision and appraisal of staff has been implemented, with appropriate records maintained. Staff confirmed that they felt well supported in their work, and the care manager discussed the process that she follows. A health and safety policy and procedure is in place, and all staff are trained in safe working practices. Contracts are in place for the servicing and maintenance of equipment at the home, and the records are well maintained with all the appropriate certificates available. The fire log indicated that fire safety checks are being carried out, with the required frequency, fire drills are undertaken and the fire risk assessment for the home is up to date, having been reviewed in June this year. The Accident Books are completed to a satisfactory standard, and Regulation 37 Notifications, which require reports to be sent to the Commission of the death, injury or serious illness of a service user, or other events in the home, are now made to the Commission, when appropriate. Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 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 2 X 3 3 X 3 Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 30 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. Standard Regulation Requirement Timescale for action 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 3 4 5 6 Refer to Standard OP7 OP10 OP14 OP16 OP18 OP19 Good Practice Recommendations Consideration should be given to the introduction of a more person centred approach to the delivery of care To ensure that residents are fully protected further review of medication administration procedures to reflect the proposed expansion of the home should be undertaken Advocacy services for a resident without family should be arranged, to ensure that any decisions that need to made are in the best interests of the resident All comments, concerns and compliments made about the home should be recorded to provide a more balanced view of the service To ensure that residents are safeguarded further training should be organised for staff on the many issues relating to abuse and protection The proposals for the upgrading and extension of the property should be implemented to improve facilities for people living at the home DS0000018631.V341471.R01.S.doc Version 5.2 Page 31 Bedwardine House 7 8 OP27 OP33 Staffing levels should be kept under review to ensure they reflect the needs of residents, and the proposed increase in numbers Quality monitoring should reflect the aims and outcomes for service users in more detail Bedwardine House DS0000018631.V341471.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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. 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