Care Home: Bishopsteignton House

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What the care home does well Those living in the home spoke highly of the staff. They said that they were kind and friendly and treated them with respect. They also said that they are encouraged to remain as independent as possible. They enjoy the social activities, particularly the trips out on the minibus which they look forward to. The standard of the food was praised and they appreciated their comments and suggestions being acted upon. The home has a stable staff team which ensures continuity of care and has resulted in good relationships between staff and those living in the home. The staff have good training programmes. What has improved since the last inspection? New care plans are being introduced which are written from the point of view of the person concerned. New menus have been introduced which have included suggestions from those living in the home. A six week plan of menus is displayed in the hall and the weeks menus are on the dining room tables. This arrangement gives everyone the opportunity to request alternatives when required. A new bath has been installed which will make getting in and out much easier. The whole house is being re-decorated. The conservatory has been replaced. What the care home could do better: Communication still needs to be improved to ensure that everyone involved with the home knows about things that affect them. The daily records need to be improved to ensure that all entries clearly show what has happened during the period of time concerned. Police checks for all new staff must be done promptly in order to safeguard those living in the home. Formal staff supervision must be re-instated as soon as possible, especially for new staff, to ensure good standards of care are maintained. CARE HOMES FOR OLDER PEOPLE Bishopsteignton House Forder Lane Bishopsteignton Devon TQ14 9SE Lead Inspector Susan Samways Unannounced Inspection 21st January 2008 12:30 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 Bishopsteignton House DS0000067788.V357638.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. Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bishopsteignton House Address Forder Lane Bishopsteignton Devon TQ14 9SE 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) 01626 770383 Coastal Care Homes Limited Vacancy Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th December 2006 Brief Description of the Service: Bishopsteignton House is a well maintained, converted Victorian property situated in the small village of Bishopsteignton. The home is set in attractive secluded gardens and is approximately two miles from the seaside town of Teignmouth. The home is arranged over two floors and can be accessed by stairs or passenger lift. There are grab rails and ramps within the home and outside the property. Communal space comprises: a large dining room with estuary views, quiet lounge, conservatory and a large entrance hall where service users often sit. The home provides personal care to a maximum of 25 service users of either gender who are over the age of 65. Community health services are accessed via local General Practitioners. Fees charged range from £430 to £550. Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced inspection which lasted for 4.5 hours. Since the last inspection the registered manager has left. A new manager was appointed in June. She was not on duty at the time of the inspection but she did come in during the afternoon to take a group out in the minibus. The senior carer on duty clearly knew those living in the home well and was able to answer questions and provide access to many of the records and documents required for the inspection. Time was spent talking to some of the people living in the home, to two visitors and to the staff on duty including the cook. Later in the afternoon the responsible individual, Mrs Nicola Rogers, arrived and remained for the rest of the inspection. Prior to the inspection the Annual Quality Assurance Assessment, completed by Mrs Rogers, had been received. This provided information about how the national minimum standards had been met, what had improved since the last inspection and future plans for Bishopsteignton House. What the service does well: Those living in the home spoke highly of the staff. They said that they were kind and friendly and treated them with respect. They also said that they are encouraged to remain as independent as possible. They enjoy the social activities, particularly the trips out on the minibus which they look forward to. The standard of the food was praised and they appreciated their comments and suggestions being acted upon. The home has a stable staff team which ensures continuity of care and has resulted in good relationships between staff and those living in the home. The staff have good training programmes. Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Communication still needs to be improved to ensure that everyone involved with the home knows about things that affect them. The daily records need to be improved to ensure that all entries clearly show what has happened during the period of time concerned. Police checks for all new staff must be done promptly in order to safeguard those living in the home. Formal staff supervision must be re-instated as soon as possible, especially for new staff, to ensure good standards of care are maintained. Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 7 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. Bishopsteignton House DS0000067788.V357638.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 Bishopsteignton House DS0000067788.V357638.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): 1,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have a comprehensive assessment and are provided with sufficient information to enable them to decide whether Bishopsteignton House is the right home for them. EVIDENCE: The home has a Statement of Purpose and Service User’s Guide copies of which were seen in the entrance hall. These provide information about the home which can aid the decision as to whether the home can meet an individual’s needs. Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 10 The files for three people living in the home were examined. The one for the person most recently admitted had a detailed assessment which covered all aspects of their life, their likes and dislikes, their preferred name and key information about their past history. Mrs Rogers, the responsible individual, stated that information received from other organisations such as health or social services is not always accurate so the manager visits everyone considering moving in to Bishopsteignton House whether at home or in hospital to complete her own assessment. Mrs Rogers also said that visits and trial periods are also offered as part of the decision making process and this was confirmed by a visitor spoken to during the inspection. Bishopsteignton House DS0000067788.V357638.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 health and social care needs of those living in Bishopsteignton House are well met and regularly reviewed. EVIDENCE: The files for three people living in the home, including that for the person most recently admitted, were examined. The newest file had a different design of care plan which is written from the point of view of the person concerned. It has headings such as ‘my medical history’, ‘my daily routine’. Mrs Rogers explained that all new care plans will use this format with the others gradually being changed when they needed to be rewritten or as time permits. Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 12 The care plans seen were detailed but the daily records varied in quality. Some entries were excellent giving good information about what the person had done or what had happened that day. Others just said ‘seems well’, ‘seems fine’, ‘quiet night’. This needs to be addressed. None of the three care plans examined or the reviews which had been carried out had been signed by the person concerned or their representative. A signature would clearly demonstrate their involvement in and agreement with the care plan. Those spoken to said that they were happy with the care and support they are given by the staff. They said that the staff are kind and friendly and treat them with respect. They also said that their G.P. or other health care professional was called promptly when required. Records of these visits and other appointments were seen in the files. The visitors spoken to also complimented the staff on the care provided. They said that they are always made welcome and are kept informed about their relatives’ welfare. Medication records were found to be correct and complete. Risk assessments were seen for the two people who manage their own medication. Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 13 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 living in Bishopsteignton House enjoy a varied social life both in the home and in the local community. The dietary needs and preferences of those living in the home are met with the provision of nutritious and varied meals. EVIDENCE: Those spoken to during the inspection said that they were happy with the activities provided. Since the last inspection an activities organiser has been engaged once a week to provide a range of things to do within the home. Coffee mornings are also arranged. However, one of the most popular things remains the trips out in the minibus available three times a week. During the inspection a group went out. On their return they were chatting to the staff about where they had been and the fact that they had enjoyed an ice cream! Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 14 Some of those living in the home also arrange their own activities such as those who set up a card table and play cards each day. Others spend time knitting, reading, listening to the radio or chatting in small groups. Religious services are held at the home at least once a month and those wishing to attend their own church are enabled to do so. Visitors confirmed that they are able to visit at any time and are always made welcome. One visitor said that they visit at different times of the day and week and always find their relative clean and tidy and happy with the way in which they are being cared for. All those spoken to praised the standard of the meals. Since the last inspection there has been a meeting at which those living in the home made suggestions for meals they would like. They also asked to know the menus in advance. As a result the menus for six weeks are displayed in the hall, the menus for the week are on the dining tables and the menu for the next meal is written on the blackboard by the dining room door. This gives everyone ample opportunity to request an alternative for a meal they do not like. The cook said how much she enjoys cooking for people who are appreciative of what she does. She said that very little food is returned to the kitchen and that was certainly the case at lunchtime on the day of the inspection. Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 15 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 living in the home are safeguarded from abuse by staff being made aware of adult protection procedures. EVIDENCE: The home has a complaints procedure a copy of which was displayed in the entrance hall and is included in the Statement of Purpose and Service User’s Guide. Those spoken to said that they knew what to do if they were to have a complaint but that they had never had cause to make a formal complaint. The visitors spoken to also said that if they had any concerns they would speak to the staff who would endeavour to resolve the situation. Mrs Rogers stated that all staff have training regarding the protection of vulnerable adults and recognising what constitutes abuse. Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 16 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): 19,20,21,22,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Bishopsteignton House provides an attractive and comfortably furnished environment, which is clean and hygienic with varied communal space. EVIDENCE: Bishopsteignton House is a Victorian building that has been converted to its present use. It has considerable communal space including a lounge and dining room, which have views over the Teign River and estuary, and a large central hall, which is used as a sitting area by many of the people living there. These are furnished in a homely way. The home also has attractive grounds, which are well used by those living in the home and their visitors when the Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 17 weather permits. The provision of garden furniture and sun umbrellas encourages them to sit outside in the fresh air. Since the last inspection a special, height adjustable bath has been installed to replace the one that was beyond repair. Various improvements to the environment are underway. The whole home is being re-decorated as was seen during the inspection. The conservatory was unable to be repaired so has been replaced with one of the same design. Mrs Rogers stated that the carpet, chairs and curtains in the main hall area are due to be replaced and the kitchen is to be re-furbished. Those living in the home and visitors all commented that the home is spotlessly clean. People can choose to look after their own rooms and make their own beds if they wish and are able to retain that level of independence. Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Those living in the home are potentially put at risk if correct recruitment procedures are not followed. EVIDENCE: Bishopsteignton House has a very stable work force, many of whom live in the village. At the time of the inspection a senior carer was in charge. Both she and the carers on duty had worked in the home for many years and knew those living there very well. Observation showed that they all had good relationships with the people living in the home. The files for four members of staff were examined one of which was newly appointed. These showed that an appropriate staff recruitment procedure had been followed with references being taken up and police checks obtained except for the newest member of staff. This member of staff had been employed for two months but only one reference had been obtained and no police check had been requested. Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 19 Training records were seen which showed that staff had received training in a range of subjects including manual handling, health and safety, fire safety, food hygiene, infection control and challenging behaviour. New training charts identify when refresher training needs to be undertaken. Five of the staff have NVQ level 2 in care and another four are working towards it. Staff spoken to said that they work well together as a team. As many of them have worked together for many years they know each other well and support each other. The cook said that she appreciates the help that she receives from the care staff at busy times and that she doesn’t usually need to ask for assistance. Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Safe working practices protect those living and working in the home but the current lack of staff supervision and issues around communication could compromise people’s safety. EVIDENCE: Since the last inspection the registered manager has left. A new manager was appointed in June but has not yet applied for registration with the Commission for Social Care Inspection. This needs to be addressed as soon as possible. Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 21 The manager was already employed at Bishopsteignton House so knew the people living and working there. The manager was not on duty at the time of the inspection but did call in to take a group out in the minibus so was spoken to briefly about registering. Unfortunately, issues about communication came up again during the inspection. A plumber arrived to do some work in some of the bedrooms. The staff on duty clearly did not know that he was coming so were unable to prepare those whose rooms were affected. This resulted in one person becoming upset at the intrusion. There is a communication book which was seen but this does not seem to entirely solve the problem. The financial affairs of those living in the home are managed by themselves or by their families. The home looks after money for some people who use their money for personal spending e.g. hairdressing, toiletries, newspapers. This money is kept under lock and key in individual containers. A record is made of all transactions and receipts are kept. Once a month the records, receipts and remaining cash are checked to make sure that they balance. These records are available for them and/or their relatives to check at any time. Only senior staff have access to this money which reduces the risk of errors occurring. Staff reported that regular supervision was not taking place at the time of the inspection. This was due to new paperwork being introduced. In addition, a new member of staff who had been in post for two months had had no supervision. Formal supervision needs to be re-instated as soon as possible. A quality assurance survey had been given to all those living in the home twelve months ago the results of which were very positive and were shared with all those involved with the home. This is due to be repeated. Staff have had training in safe working practices and dates when refresher training is due have been recorded. Mrs Rogers stated that more training is planned. Staff have access to a file containing information about all the potentially hazardous substances used within the home and what to do should an accident occur with one of them. Equipment within the home has had safety checks carried out. Fire safety checks had been carried out at the required intervals and accident records had been completed correctly. Water temperature regulators have been fitted to baths and basins. Door guards have been fitted to doors to communal areas and bedrooms where requested. Some radiators not yet covered are due to be shortly. Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 22 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 x 3 2 x 3 Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP29 Regulation 19 Requirement Police checks for all new staff must be done promptly in order to safeguard those living in the home. Timescale for action 29/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. Refer to Standard OP7 OP32 Good Practice Recommendations The daily records need to be improved to ensure that all entries clearly show what has happened during the period of time concerned. The registered provider should consider ways of improving their communication with all those involved with Bishopsteignton House. Formal staff supervision must be re-instated as soon as possible, especially for new staff, to ensure good standards of care are maintained. 3 OP36 Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Regional Office Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Bishopsteignton House DS0000067788.V357638.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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