Care Home: Bluebell Nursing Home

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What the care home does well There is an ongoing refurbishment programme in place and a number of the rooms have been redecorated. The meals at the service are good and meet with the satisfaction of the people living there. Training provision means people living at the home are supported and cared for by a staff team that have the relevant skills and knowledge.Bluebell Nursing HomeDS0000062757.V378802.R01.S.docVersion 5.2 What has improved since the last inspection? New care planning processes have been implemented. The care plans are person centred addressing individual needs and wishes. The care planning process ensures people’s health needs are assessed and relevant action taken. This means care areas such as nutrition and details about pressure relieving management at the home is undertaken safely. Pre admission assessment processes have been embedded into practice to ensure people’s needs can be met when they move into the home. People living at the home are able to take part in a variety of meaningful activities which are now coordinated by a dedicated member of staff. Medication management means people receive their prescribed medications at the correct times in a safe manner. The management of medications prescribed to be taken as required means that people receive these medications only when they are needed. People living at the home are protected from effects of abuse by a staff team that has a good understanding about safeguarding procedures. The home has demonstrated it manages safeguarding issues effectively, including informing the relevant authorities about any concerns. The manager keeps under review the numbers of staff on duty at any one time and ensures there are sufficient numbers of staff to meet the needs of people living at the home. This has included making changes to staff working times to meet the needs of people living at the home. First aid training has been completed by staff members to ensure there is a suitably first aid qualified member of staff on duty at all times. Recruitment procedures ensure that all required checks are received by the home prior to a person commencing work at the home. This means the home can assess the person suitability to work in a care home prior to the person commencing work at the home. Quality auditing processes continue to be developed and embedded into practice including auditing of clinical issues and falls. The home now has a registered manager. What the care home could do better: Bluebell Nursing HomeDS0000062757.V378802.R01.S.doc Version 5.2 Fluid charts for people receiving nutrition by tube feeds must clearly identify the amount of feed and fluid had by the individual person. It may be appropriate for the home to consider varying the questions in the regular satisfaction surveys to encourage continued response to the surveys. Following changes made to the running of the home, Bluebell Nursing Home was assessed as providing adequate outcomes for people living there in August 2008 and February 2009 having previously been assessed as providing poor outcomes. Changes have continued to be made which means the home is now providing good outcomes for people living there. These changes must continue must be sustained and embedded into practice to ensure people living at Bluebell Nursing Home have the best possible outcomes. Key inspection report CARE HOMES FOR OLDER PEOPLE Bluebell Nursing Home 45 - 53 St Ronan`s Road Southsea Hampshire PO4 0PP Lead Inspector Gina Pickering Key Unannounced Inspection 17th December 2009 10:00 DS0000062757.V378802.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bluebell Nursing Home Address 45 - 53 St Ronan`s Road Southsea Hampshire PO4 0PP 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) 023 9282 3104 023 9282 6109 suecollins@whnh.com www.bluebellcarehome.com Techscheme Ltd t/a Bluebell Care Home Ms Joanna Doe Care Home 51 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0), Physical disability (0) of places Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) 2. Physical disability (PD) The maximum number of service users to be accommodated is 51. Date of last inspection 25th February 2009 Brief Description of the Service: Bluebell Nursing Home is registered with the Commission for Social care Inspection (CSCI) to provide nursing and personal care to 51 people in the older person category. The home is situated in Southsea and is close to the pier and seafront, a predominant feature of the area, which is well serviced by local bus companies. The service is within access to local amenities of Southsea’s shops and the local hospitals. The nursing home is comprised of five period town houses combined to create a single building, with three separate floors and two mezzanine floors. The home has a small garden to the back with seating provided. Bluebell Nursing Home DS0000062757.V378802.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. As part of the inspection process a visit was made to the service on 17 December 2009. During this visit we looked at documentation relating to people living at the home as well as having conversations with people living at the home. We looked at various documents relating to the running of the home, considered the environment of the home including communal and private areas and had conversations with the manager, the responsible individual, visitors to the home, people living at the home and staff members. The inspection took place prior to the Annual Quality Assurance Assessment (AQAA) being returned to the Commission, the return date being after the inspection. Information we received in the AQAA has been considered prior to this report being published. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. We have sent out some surveys to the service and the comments received will be reflected in this report. What the service does well: There is an ongoing refurbishment programme in place and a number of the rooms have been redecorated. The meals at the service are good and meet with the satisfaction of the people living there. Training provision means people living at the home are supported and cared for by a staff team that have the relevant skills and knowledge. Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.2 Page 7 Fluid charts for people receiving nutrition by tube feeds must clearly identify the amount of feed and fluid had by the individual person. It may be appropriate for the home to consider varying the questions in the regular satisfaction surveys to encourage continued response to the surveys. Following changes made to the running of the home, Bluebell Nursing Home was assessed as providing adequate outcomes for people living there in August 2008 and February 2009 having previously been assessed as providing poor outcomes. Changes have continued to be made which means the home is now providing good outcomes for people living there. These changes must continue must be sustained and embedded into practice to ensure people living at Bluebell Nursing Home have the best possible outcomes. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 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 Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. People using 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. Pre admission processes mean people move into the home believing the home can meet their needs. Information is provided to give people an understanding of what it is like to live at the home; this should be provided in different formats to ensure all people have access to some infomrtaion about the home they can understand. EVIDENCE: The home has a statement of purpose that sets out the service provided at Bluebell Nursing Home. We had a look at this document. Details within it Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 Page 10 comply with the relevant requirements as set down by the Care Home Regulations 2001. However it is not clear whether the home has considered alternative formats for people that have difficulty understanding the written word. The home has people moving in who have varying degrees of dementia, and because of their mental cognition not all will be able to understand the written word. The home should provide the information in a format other than the written word to allow more people an understanding about the service provided at the home. The statement of purpose details ‘a full nursing assessment of each prospective resident is carried out prior to admission by our matron or another senior registered nurse to ascertain whether the home would be right for them’. The AQAA stated ‘the pre-admission assessment is thorough and detailed to ensure that a prospective service user’s needs can be met’. It is detailed in the last inspection report that the service had recently started admitting people to the home following the lifting of a voluntary agreement not to admit. There was a pre admission process in place. However this had been not embedded and needed to be sustained in practice. Records that we looked at for this inspection evidence that this process is being embedded into care practices. The home has invested in a new care planning process, which includes the pre admission assessment, which was implemented in July 2009. We looked at records for five people living at the home. They all had an assessment completed of their needs prior to them moving into the home. Two of the people had assessments completed with the new format. The assessment process included all aspects of the person’s personal care needs, their views on moving into a care home, social care needs and details of where and from whom information was obtained. For people funded by social services there was also a copy of the care management assessment of the person’s needs. The manager told us they have made changes to the pre admission assessment process in response to incorrect information they had been given by other health care professionals about a person’s wounds. This indicates the home identifies short falls in its service and responds in an appropriate manner to improve outcomes for people living at the home. Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11. People using 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. Care plans for people living in the home are person centred detailing the actions needed to meet people’s individual personal and health care needs including end of life care. Health needs of people living at the home are met by effective use of monitoring processes and prompt referral to relevant healthcare professionals. Management of medications is protecting the welfare of people living at the home. People living at the home have their privacy and dignity protected. EVIDENCE: Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 Page 12 The inspection report dated 25 February 2009 detailed that details in care plans did not always accurately reflect all the current needs of the person living at the home. Examples included lack of detail about pressure relieving equipment and continence management. A requirement was made regarding this issue. Concerns were also noted in February 2009 about the management of people’s specific dietary needs including the safe use of thickening agents in fluids and drinks and a requirement was made that ‘the service users health and personal needs are met at all times through detailed dietary assessments and actions plans to meet these needs.’ As part of our inspection process we looked at the care planning documents for five people living at the home. We were told the home has invested in a care planning process that they believe will result in care plans being person centred by identifying people’s individual personal, health and social care needs. From these assessments individualised care plans are developed and kept under review. In each of the plans we looked at there were completed assessments including those for personal care, safety, nutritional, mental health needs, skin integrity and social needs. Each person had a moving and handling risk assessment. This included details about any equipment used to support the person with moving including the type of hoist and sling used and what type of movement it is used for. For example some people required different hoists for getting in and out of bed and getting in and out of the bath. Details about the assistance and equipment needed for moving and handling were included in the relevant care plan. Assessments were in place for the risk of falls and relevant personalised plans developed from these assessments. For people whose assessments indicated forms of restraints, such as bed rails, were required to ensure their safety relevant assessments for the use of the restraint were completed along with signed agreements from the person involved, or their legal representatives. We saw examples of actions taken by the home to reduce the risk of falls for people living at the home. This included for people who liked to mobilise independently but were at risk of falls when unsupervised the use of chair alarms in their bedrooms that alert staff to the person moving so they can attend to them and support them with walking. Accident records evidenced that since the home had started using these alarms the incidents of falls had reduced. Other examples include the use of mattresses on the bedrooms floors. This is for people who have been assessed as likely to harm themselves if bedrails are used. They have a low bed and mattresses on the floor to protect them from injury if they fall off the bed. Personal care and dressing care plans identified what the person could do for themselves, what they needed assistance with and how they like that assistance to be given. This included the gender of carer they prefer for personal care, the toiletries they like to use and for the gentlemen whether they prefer and wet or electric shave. People living at the home who we had Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 Page 13 conversations with confirmed that staff supported them with washing and dressing in the way they wished. Assessments for skin integrity included the use of a professionally recognised tool for assessing a person’s likelihood of developing pressure ulcers as well as general details about the condition of a person’s skin which could include any wounds or skin problems such as dry skin or eczema. Care plans included details about pressure relieving equipment required including the relevant settings of mattresses, detailed plans and monitoring of wounds and details of creams being applied to maintain skin integrity. Details about people continence needs were included in the assessment and care planning documents. This described the help they needed to remain continent including any assistance needed to go to the toilet and if required the type of protective pad and how often they are changed. Assessments for dietary requirements included the use of a professionally recognised tool for assessing a person’s nutritional status, details of food and drink likes and dislikes, details of any problem the person might have with eating or swallowing and any restrictions in diet due to medical needs. Care plans detailed involvement of relevant health professionals for people with specialised dietary needs. This included speech and language therapists, dieticians and specialist nutrition nurses. Care plans detailed the amount of thickening agents required by people as directed by the relevant health care professional to be used in food and drinks to ensure food and drink is swallowed and not inhaled. We observed people receiving correctly thickened fluids. We were told that kitchen staff have the same information about the thickening of fluids and the thickness of pureed food required for people living at the home. This was confirmed in conversations with kitchen staff and ensures people receive their meals of a consistency they can safely swallow. Care plans detail if records need to be maintained of a persons’ fluid and dietary intake. For those plans we looked at that detailed such records must be kept they were being completed. New fluid recording charts had been introduced for detailing the amount of nutrition and fluid given to people receiving their nutrition though feeding tubes. The details on these was confusing, it was difficult to identify exactly how much had been given and different staff members were completing them in different ways. This put people having nutrition and fluids via feeding tubes at risk of not receiving the correct amount of feed and fluids to maintain their health and wellbeing. This was discussed with the manager. Records for people taking fluid and diet normally detailed when drinks and food were being offered, how much was being taken and if they were being refused. Records were maintained in each persons documents about contacts with health professionals. This included GP’s, District nurses, occupational therapists, physiotherapists, chiropodists, dentists, community psychiatric Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 Page 14 nurses and opticians. There was evidence of the involvement of occupational therapists to obtain relevant seating to meet people’s needs and the involvement of physiotherapists to maintain and improve the limb functions of people living at the home who were immobile. All personal care is carried out in the privacy of the person’s bedroom or in one of the bathrooms or shower rooms. Shared rooms have ceiling mounted curtains to promote privacy and dignity. Screens were available in communal areas to maintain a person’s dignity and privacy if for some reason they needed attention in one of the communal areas. The inspection report dated 25 February 2009 details shortfalls in medication management systems at the home with a requirement being made that arrangement must be ‘in place for the safe administration, recording of medication received into the care home.’ We looked at the medication management systems including the documenting of medications received into the home, administered to people and destroyed, the storage of medications and the administration of medications. We looked at the medications Administration Record (MAR) charts for people’s whose care plans we had looked at. All clearly detailed the name and dosage of the medication and the time that it was to be administered. We checked the details on the MAR charts against the stock of medicines held at the home for four people living there. These records corresponded indicating that people at the home were receiving medications at the time prescribed to them. Copies were available at the home of each person’s prescription, meaning it could be assured that people were receiving the medications prescribed to them by their medical practitioner. There were clear guidelines for the use of medications to be taken when required, for example the use of pain killers, which detailed the reasons for their use, how much should be used and any side effects from their use. There was a separate folder with individual MAR sheets for items such as creams and thickening agents that detailed the reasons for the items being used and how they should be used. Staff signed for each time these were used. The storage of medications was in a clean and orderly manner. Each persons care plans contained details of their wishes regarding end of life care, whether they wanted to be admitted to hospital or not in the event of deterioration in their health. The AQAA told us the home uses a professionally recognised care planning system called the Liverpool Care Pathway for people who are in the final stages of their illnesses. We did not see any of these during our visit to the home. The AQAA told us the home makes use of palliative care teams, for some people were saw evidence in their documents of the involvement of a palliative care team. The manager told us that the local GP’s wished to become more involved in each person’s plans for their end of life care and for some people living at the home there was documented evidence of involvement of their GP in planning their end of life care. Staff records detailed training about palliative care had been received. Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 Page 15 Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People using 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. People living at the home have the opportunity to take part in meaningful activities and social interaction that are of interest to them. Visitors can be received at times suitable to people living at the home. People living at the home benefit from the provision of a varied and balanced diet that allows them choices at meal times. EVIDENCE: The inspection report dated 25 February 2009 detailed a shortfall in the provision of activities and social stimulation for people living at the home. There was no activity coordinator, the recording of activities that people took part in were not good and there was a lack of social stimulation for people with dementia and those who were unable to or chose not to leave their bedrooms. Since that inspection an activity coordinator has been employed to coordinate Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 Page 17 activities at the home. Care plans detail the present and past interests of people living at the home. The manager and the activity coordinator told us they have tried to obtain a life history for all people living at the home so they can plan care and activities around their lifestyles, but in some cases this has been difficult when the person has no family members. As part of the programme of activities the home had been organising a ‘Round the World Cruise’ in which a country of the world was chosen and activities were planned around the culture, history and food of that country. A map of the world was displayed in one of the Communal areas charting the countries visited by the home. Countries visited included China in which people living at the home had made Chinese decorations and had Chinese food to eat. There had recently been an Icelandic theme, some of the décor from this was now been utilised in the Christmas decorations to provide a wintry atmosphere at the home. The Activity coordinator had recently organised an activity titled the ‘Dignity Tree’. People living at the home had been asked to make comments about what dignity meant to them. These had been written on paper leaves and attached to the Christmas tree. This had provided information to the home about the personal values of people living at the home, interests and hobbies that were important to them and how they like to be thought of. We were told that information from this exercise was going to be used to plan future activities as well as being a learning resource for care staff about respecting the dignity of people living at the home. Records are kept in individual folders about the social activities and one to one activities they partake of. Visiting entertainers to the home includes musical entertainers, dog therapy and exercise to music groups. Religious needs of people living at the home are met by a variety of visiting church representatives from various denominations. A file is available at the home that describes each of the large planned activities that have taken place; this includes photographs from the activity. Discussion with activity coordinator indicated that for people who stay in their bedrooms she ensures she spends time with them either discussing the theme for the month or discussing their interests and hobbies. The activity coordinator has completed training about dementia, the information from which has assisted in planning activities for people with cognitive and sensory impairments. The home is a member of the National Association for Providers of Activities for Older People which provides them with support, information and training to equip staff with skills to enable older people enjoy a range of activities in the care home setting. People living at the home told us they enjoy the opportunity to take part in activities and social events. People who we saw staying in their bedrooms told us they make the decision not to join in with group activities. It was noted that for these people they had interests they could take part in in their bedrooms such as television, films, books and jigsaws. We saw that for some people with sensory needs there was sensory equipment such as lights and music in their rooms for their enjoyment. The activity coordinator told us that as a result of Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 Page 18 finding information about people’s life histories and past interests she had been able to introduce outside visitors that were specific to that persons interests but would also interest others living at the home. One example given of this was regular visits from the Salvation Army band; one person living at the home having been a member of the Salvation Army in the past. The statement of purpose states that people can receive their visitors at any time of the day. The visitors log book detailed people visiting at various times of the day and conversations with had with the many visitors to the home indicated they can visit at the times to suit their relative or friend living at the home. The care planning system means staff at the home are made aware of peoples choices about social activities and food choices. People living at the home told us in conversations that they can make choices about their daily lives and that staff at the home respect their choices. There was evidence in people’s documents their mental health and ability to make decisions is considered and for some people there was evidence of involvement of mental capacity advocates and mental capacity assessments in the making decisions about medical interventions. Meal provision at the home allows choices at all meal times for people. Records are maintained of the choices offered and taken by people living at the home. The dining room is not of a sufficient size to accommodate all people at a meal time. We observed some people taking their lunch in the dining room, some in the lounge areas and others in their bedrooms. Conversations with people having their lunch in their bedroom evidenced it is their choice to do so and the manager told us that if more people wanted to take their meals in the dining room a two sitting service would be arranged for meal times. Conversation with the cook indicated the menu plan takes into account the known food preferences of people living at the home and current good practice guidelines about nutrition in the elderly. He confirmed that he is aware of the consistency to puree food to for each individual who has swallowing difficulties for whom pureed food has been recommended. Food we saw being presented to people was attractively presented, including pureed meals. Where it was required staff assisted people at meal times with sensitivity. Snacks are available at all times of the day; the cook prepares healthy snacks that people can access from a fridge located in one of the communal areas. Concerns were noted about the recording of fluid and nutrition intake for people being fed through feeding tubes. Information about this is detailed in the health and personal care section of this report. Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People using 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 responds to complaints in a prompt and positive manner, incorporating complaints into part of their quality assurance processes. People living at the home are protected from the effects of abuse by a staff team that has a good understanding about safeguarding procedures. EVIDENCE: The home has a complaints procedure which is displayed in the entrance to the home and is available in the Statement of Purpose. A record of complaints received is maintained. A complaint log book details the complaint received and where further information about the complaint is located. The responsible individual told us this practice had been introduced to ensure confidentiality of information but also enables access to the information when required. The log detailed responses had been made to complainants. Details were also included in the log of any safeguarding issues arising at the home. There was one such incident detailed that had occurred since the last inspection. The home had Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 Page 20 informed us about this incident and had invoked safeguarding procedures informing the relevant authorities. People living at the home that we had conversations with told us staff at the home listen to their concerns and act on them. The service also provides opportunity with satisfaction surveys for people to express any concerns or complaints they may have. Procedures are in place about the safeguarding of vulnerable adults. Records detailed that all staff have completed training about the protection of vulnerable adults. Discussion with staff members indicted a good understanding about safeguarding and they knew what actions to take should they suspect an act of abuse had occurred. Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. People using 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. People are provided with a homely and well maintained environment to live in that has the relevant aids and equipment to allow their needs to be met. EVIDENCE: Communal areas of the home consist of a dining room, lounge areas and several smaller alcove areas with seating. The statement of purpose details that bedrooms can be personalised with items belonging to the individual. Bedrooms that we looked at were individualised with personal belongings to varying degrees. Ceiling tracked curtains provided privacy in shared Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 Page 22 bedrooms. Appropriate equipment to meet the personal, health and social care needs of people was evident in their bedrooms. This included pressure relieving equipment, chair alarms, profiling beds, televisions, and sensory equipment. It is evident that changes to the environment are being made to improve outcomes for people living at the home. This includes overhead hoists in bathrooms so all people living at the home have access to bathing facilities, a new ‘wet room’ allowing people greater choice of bathing facilities, the extension to the patio area enabling all people to have access to the garden and additional grab rails for the safety of people who are independently mobile. To promote increased observations and greater continuity of care for people the home has now been organised into two ‘ nursing units’; one on the ground floor and one on the first floor. This has meant further changes to the environment including a nursing office and medication storage are on the first floor. The home has a laundry where all the personal laundry belonging to people living at the home is undertaken. The laundry was clean and tidy, with wall and floor surfaces being of a finish that was easily cleanable. The home employs a team of maintenance men. Records indicate there are good systems in place for reporting and attending to any maintenance issues. This ensures people live in a safe and well maintained environment. A team of housekeepers are responsible for maintaining the cleanliness of the home. All the areas of the home that we looked at were in good decorative order and clean. There was no malodour at the time of the visit. There was evidence of appropriate infection control procedures. Gloves and aprons were available for staff to use. Suitable hand washing facilities were available along with hand gels to reduce risks of cross infection. However it was noted at one point that a bag of dirty linen was being stored leaning against moving and handling equipment. This was promptly moved once it was pointed out to staff members. Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 18, 19 & 30. People using 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. People living at the home are being cared and supported by staff members in sufficient numbers who have received training to equip them with the relevant skills and knowledge. Recruitment practices are ensuring that people employed at the home have the relevant skills and experience and are suitable to work in the care industry. EVIDENCE: Following the inspection in February 2009 a requirement was made that the home ‘must ensure there are adequate trained staff in sufficient numbers to meet the assessed needs of people living at the home at all times.’ This was because the duty rota did not clearly indicate the hour’s staff were working at night which meant it could not be assured there were sufficient staff at night to meet the needs of people living at the home. Copies of the duty rota we looked Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 Page 24 at clearly detailed the hours staff were working, including day staff, night staff and ancillary staff. The manager told us she uses a dependency tool to help her assess whether there are sufficient staff on duty at any one time, and if she believes there is a need to have further staff on duty she will discuss this with the responsible individual. She told us that in response to people’s needs and wishes to rise early a member of day staff is now rostered to commence work at 7am rather than 8 am. This was evidenced on the duty rota. Both staff and people living at the home we had conversations with indicated they felt there were sufficient staff working at all times to meet the needs of people at the home. The duty rotas detailed there were sufficient ancillary staff on duty at any one time including maintenance, housekeeping, catering and laundry staff so that care hours are not eroded by non care duties. To promote increased observation and continuity of care for people living at Bluebell the home has now been organised into two ‘ nursing units’; one on the ground floor and one on the first floor. Each unit has a registered nurse appointed as head of the unit. A designated staff team is allocated to each of the units. The duty rota and discussion with staff members confirmed this new way of working is taking place and because of this system they are getting to know the people living at the home as individuals. The home employs a member of staff who is responsible for coordinating and monitoring the training of all staff. A training matrix enables easy monitoring of the training staff have undertaken and identifies training required. This record detailed that all staff have completed mandatory training about health and safety issues such as fire safety, moving and handling, food hygiene and the protection of vulnerable adults. It is detailed in the report dated February 2009 that there were insufficient numbers of staff who had completed first aid training. Training records detailed that all nurses had now completed first aid training, which means there is always a member of staff on duty who has relevant first aid skills. The manager and training coordinator told us they try to provide training for staff on specific care issues that are related to an individual or group of individuals living at the home. Examples include the provision of training from relevant health care specialists about tube feeding prior to people moving into the home who required tube feeding. Records detailed that staff have had training about the care of people with dementia. The manager told us further dementia training is being organised for all staff members including non care staff to ensure people living at the home who have dementia are supported and cared for by staff members who all have a good understanding about the illness and it’s affects on people. Discussion with ancillary staff evidenced they receive training about issues such as dementia, communication and relevant diseases to ensure they also have the skills to communicate and interact with people living at the home. Records also detailed that all new staff complete an induction programme that complies with the Skills for Care common induction guidelines. Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 Page 25 Shortfalls were identified at the last inspection with recruitment procedures resulting in a requirement being made that all necessary checks are in place prior to a person commencing employment. We looked at the recruitment records for four recently recruited staff members, evidencing that all recruitment checks were received prior to the person commencing employment. This means the home is doing all it can to ensure they recruit staff who are suitable to work in the care industry. Records detail that over 50 of care staff have achieved NVQ level 2 or above in care with further staff members having been allocated to undertake NVQ studies. The manager and training coordinator told us they are committed to all care staff having as a minimum NVQ level 2 in care to ensure people living at the home are cared and supported by staff who are skilled and experienced. Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. People using 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 management of the home is committed to improving outcomes for people living at the home. The views and opinions of people living at the home are listened to and considered in the development and running of the home. The finances of people living at the home are protected. The health and safety of people at the home is protected. EVIDENCE: Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 Page 27 The home has a manager who was registered by the Commission in March 2009. Since her appointment she has made changes to the running of the home with the goal of improving outcomes for people living at the home. Examples include changes to the duty rota to ensure there are sufficient staff available in the mornings to assist people at the time they wish, the organisation of the home into two ‘nursing units’, development of staff to take on specific roles such as coordinating training and clinical auditing and the introduction of person centred care planning. She told us she is supported by the registered providers; one of whom acts as the responsible individual and is available at all times for support and assistance. The registered provider and registered manager have demonstrated their commitment to complying with legalisation and have ensured all requirements from the previous inspection have been complied with. It was detailed in the inspection report dated 25 February 2009 that there had been ‘recent introduction of internal audit, however it was not sufficiently detailed to ensure that people’s views are being fully reflected in outcomes for people living in the home.’ At this inspection we found the home seeks the views of people living at the home by the use of regular surveys to both people using there and their representatives and by the use of ‘resident and relative meetings.’ Surveys are completed 3 to 4 monthly. The results of these are collated by the registered persons and action taken accordingly. It was noted that the same questions are used each time a survey is completed. It may be appropriate for the home to use different questions to encourage continued responses to the surveys. Comments received from surveys included ‘my mother is very happy with you and me and her family i.e. sister and grandchildren can’t praise your staff enough’ and ‘Bluebell is in opinion of my wife and myself to be first class and friendly caring home and we both consider my sister to be very fortunate to be in such a care home as Bluebell’. Concerns raised by this process included the lack of NHS chiropody provision for people with specific health care issues – the manager told us she is trying to address this issue and has spoken to the relevant person living at the home and his/her family about it. Records detailed that each person living at the home has a yearly review completed at which stage the views of person, their relatives and any representatives are sought with regard to any aspects of living at the home. A three monthly news letter informs people living at the home and their representatives to be informed about various aspects of living at the home. A development plan for the service is generated annually which uses feedback from surveys, resident and relatives meetings and complaints. We were told that the development plan for the next year was in the process of being developed as it is produced annually at the same time as completing the AQAA. We received the AQAA within the required time scales after completion of the site visit. It detailed planned changes in the running of the home for the next year that included the views of people living at the home. Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 Page 28 Other actions taken by the home to assist auditing the quality of the service provided includes the auditing medications, pressure area care, falls, monthly unannounced visits to the service by a representative of the registered provider to monitor how the home is meeting its commitments and the consideration to all complaints received by the service. The home does not look after the personal allowances of anybody living at the home, but there is a safe for keeping small amounts of money and valuables. We looked at records for four people living at the service and evidenced the records matched the money and valuables held for each individual in the safe. There is a plan in place for staff to receive two monthly formal supervision sessions. Staff records detailed this is occurring which means people are being cared and supported by staff who are appropriately supervised. It was noted at the last inspection that the home had not notified the Commission of an incident that had the potential to affect the welfare of people living at the home. Since that inspection our records detail the home has notified us of incidents affecting the welfare of people living at the home and we did not identify any shortfalls in the process during our visit to the home. The manager demonstrated that the health and safety of all people at the home is considered at all times. Records detailed that all staff have completed relevant training about health and safety issues. For all people living at the home there were appropriate risk assessments including an assessment of their room environment with actions detailed to be taken to reduce any identified risks. The home provided evidence to indicate compliance with relevant fire safety regulations. We saw copied of service certificates for the gas systems, lifts, hoists and the specialist mattresses evidencing the home ensures maintenance of equipment and services in accordance with relevant guidelines for the protection of all people at the home. Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 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 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 3 3 3 Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 Page 30 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 OP8 Regulation 1(a) Requirement Accurate records must be kept of feeds administered to people by tube feeds. So it can be assured people are receiving the nutrition and hydration needed to maintain their health and wellbeing. Timescale for action 30/01/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bluebell Nursing Home DS0000062757.V378802.R01.S.doc Version 5.3 Page 31 Care Quality Commission Care Quality Commission South East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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