Care Home: Bungay House

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What the care home does well The service provides a homely feel that is promoted by the staff. Residents who made comments during our visit said they liked living in the home, one said "I am happy and the girls are good to me". The service continues to provide a variety of good nutritional food with choices available for all the residents. One resident told us she enjoyed the meals and the staff ask her every day what she wants to eat. The service continues to have a good team of staff that are committed to caring for the people who live in the home. One resident commented "they are lovely girls". By sending out surveys to various agencies, residents and relatives monitors the service that it offers. What has improved since the last inspection? The process for assessing prospective residents has improved so that no one is admitted to the home unless the service is sure that their needs can be met. Improvements have been made to the care planning system. Some more improvements have been made to the overall ambiance of the home. The area around the approach to the home has been tidied up and the redundant washing machines have been removed. The process for formal supervision has improved. The system for recruitment has been made more robust. What the care home could do better: Ensure that the use of as required medicines are supported with a plan of care to justify continued use. The manager must make sure that she attends training for safeguarding adults. Although the care planning system has improved the service must continue to update the system and ensure all the care plans are easy to use. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bungay House 8 Yarmouth Road Broome Bungay Norfolk NR35 2PE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marilyn Fellingham     Date: 0 6 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Bungay House 8 Yarmouth Road Broome Bungay Norfolk NR35 2PE 01986895270 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Bungay House Ltd care home 12 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Additional conditions: 12 12 The 12 Mentally Disordered people may be admitted if 50 years of age or older. Date of last inspection Brief description of the care home Bungay House is situated in the village of Broome on the border of Suffolk and Norfolk. The entrance to the home is signposted from the road. The home can accommodate 12 people aged over 50 years with either mental health illness or dementia. There are 2 double and 8 single rooms on the ground and first floor; none of these rooms have en-suite facilities. There is a separate dining room, sitting room and a small area that can be used as a quiet area or for activities. There is a pleasant small courtyard garden to the front of the premises with a large covered area for those residents who wish to smoke. There is limited parking to the side of the home. Care Homes for Older People Page 4 of 26 Brief description of the care home The home is supported by the local GP surgery and other professional agencies. A copy of the last inspection report is available from the manager of the home. The range of fees charged for care and support services are £475 to £695 per week. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection that was undertaken by two inspectors over six hours. The key inspection for this service has been carried out using information from previous inspections, information from the Annual Quality Assurance Assessment (AQAA), some residents and people who work in the home. The AQAA is a report that the manager has to fill in and send to us to tell us how the service is operating. We use the information provided to plan our inspection visit. The main method of inspection used was case tracking. This involved selecting individual care plans and information available about people who live in the home and Care Homes for Older People Page 6 of 26 tracking their experience as a result of the support provided. During our visit a tour of the premises was undertaken and residents records and staff files were looked at. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are assessed prior to admission to ensure that the home can meet their needs. The prospective residents are well informed about the home so are able to make a decision about living there. Evidence: We looked at two records of assessment for newly admitted residents, we noted that a full assessment of needs had been carried out for both residents. The assessments were detailed and contained information relevant to these residents. We asked the manager if a letter of confirmation was sent to the prospective residents confirming that their needs could be met, she told us that this did not happen but was keen to assure us that it would be done in the future. We spoke with one of the new residents who confirmed that they had visited the home and that they had been given sufficient Care Homes for Older People Page 11 of 26 Evidence: information about the home to enable them to decide if they wanted to live there. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Variable practise related to some areas of the planning and delivery of care means that the residents cannot always be sure that their health, personal and mental health needs can be fully met. However we hope the new care planning system that is to be put in place ensures that the residents needs are met in total. Residents can be sure that their medicines are handled and administered safely. Evidence: We looked at four care plans for people who were living in the home, they were still muddled in part and did not contain clear guidelines for care; however the service has employed an external consultant to help them with the care planning system. A new system for care planning is being put into place although two of the care plans using the new system were still muddled and not clear about prescribed care. We noted that the care plans still lacked some details for care that makes it difficult for the staff to deliver needs related to needs of the residents; we also noted lack of Care Homes for Older People Page 13 of 26 Evidence: evaluation of care. There were no plans of care in place for those residents who are prescribed p.r.n. as prescribed medication, these are required to justify the continued use of such medicines. Two members of staff we spoke with understood the care planning process. We undertook a random audit of medicines and found that the amount of medicines in stock tallied with the medicine record charts of prescribed medication. We observed the interaction between the staff and the residents and noted that the residents were being treated with respect. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The range of activities offered by the home means that the residents have an opportunity to participate in motivating activities. Meals and mealtimes are not rushed and appear to be a social occasion for all residents. Evidence: We were able to discuss with the manager, two members of staff and two residents about the activities provided by the home; we were also able to observe some social interactions taking place between the residents and the staff. The staff and manager told us that there is now a wide range of activities provided by the home; the two residents we spoke with told us about what they had been doing, one told us we listened to the music man and sang along with him; another resident told us that they had been taken out for walks. We saw records for the activities that had taken place, these included bingo, exercises, music and movement and visits by the music man. It was the cooks day off on the day of the inspection. One carer organises the meals to cover cooks days off. Todays meal was fish and chips, semolina or fruit salad. All residents who were spoken to stated that they enjoyed the meals and that they Care Homes for Older People Page 15 of 26 Evidence: took it in turns to put their ideas forward to the cook when they got together in meetings. The menu covers a 4 week period, this was seen and although some days the meals were a little plain, there were plenty of alternative options including fresh fruit and vegetables to allow a healthier option. There was evidence that the cook caters for a diabetic diet, no other dietary requirements were needed for the current residents, a list of the residents likes and dislikes were stored in the kitchen. The food stores contained good quality food. One resident said she enjoys the meals she gets and the staff ask her each day what she wants. She said she has put on weight since she has been at the home, she can no longer make her own cup of tea, she knows that the other residents can go into the kitchen to make their own drinks. She is offered regular drinks by the staff. The kitchen was clean and tidy, and the cook had a risk assessment within the kitchen area to be able to manage the risks to residents who regularly make their own drinks and help in the kitchen. The cook and a selection of the care staff hold the food hygiene certificate. The dining room was very pleasant with table cloths on all the tables, the residents were talking to each other and the atmosphere was a happy and unrushed. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel listened to and staff have been given the knowledge to protect the residents. The manager needs to attend safeguarding training to ensure all complaints are dealt with effectively. Evidence: A complaints procedure is in place and is made available to the residents and significant others. We talked to two residents who said they knew who to go to with any concerns, one said I dont have any concerns. We looked at the records for complaints and how they had bend dealt with, there were not a significant in numbers and all had been resolved. We noted from discussion with two staff members and looking at training records that the staff have received training in issues related to safeguarding adults, however the manager has not and when asked does not have sufficient knowledge to make an adequate referral if needed about abuse. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained environment which is homely and comfortable. Evidence: A tour of the building was undertaken and every bedroom was seen. The home was clean and contained comfortable furniture. During the tour, residents were using all areas of the home, one was helping in the kitchen, another was having her hair done by the hairdresser, and another was in the garden. The building is a converted barn with an extension containing some of the bedrooms and laundry room. There are two shared and eight single bedrooms, none have en suite facilities although there is a toilet and bathroom on each floor. The upstairs toilet does not have a sink in it and a requirement was issued for residents hygiene reasons, the owner has looked into how this can be achieved, so the current situation for using the sink in the next bathroom continues. All the bedrooms were clean and comfortably furnished, containing residents personal possessions. One bedroom was currently vacant. The shared bedrooms contained a curtain to allow for privacy. Evidence of new carpets and repainting bedrooms showed that the owner is currently updating the premises. There is an enclosed garden at the front of the home, one of the residents enjoys Care Homes for Older People Page 18 of 26 Evidence: having a small area to grow there own plants. There is a covered patio for those residents who smoke and like to sit outside. The staff undertake the laundry requirements of the residents, there was bleach left out in the unlocked laundry room. A requirement was issued to remove and store the bleach under COSHH regulations. The manager actioned this immediately. The manager discussed future plans regarding the continuing refurbishment and redecoration of the building. Since the last inspection the kitchen tiles and flooring replaced. The ground floor lounge has had the carpets and blinds replaced. The cupboard under the stairs is now used as a storage area. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are available in sufficient numbers to look after and support the people living at the home. Evidence: Inspection of the staff rotas, observation during this visit and discussion with residents and staff on duty demonstrated that there are enough staff on duty to meet the needs of the residents. The manager provided evidence that some of the staff are undertaking the NVQ accreditation although the number is just fifty per cent. Staff files were also checked, these showed that the manager followed a clear recruitment procedure when employing new staff for the protection of residents. Training for staff had been updated including food hygiene, infection control, dementia awareness, and there was a training programme in place for the rest of the year. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are management arrangements in place to make sure that people who use the service are not put at risk and their independence and choices are not restricted. Evidence: During our visit we spoke with the owner, the manager and two members of staff. The staff members felt that they had good support from their manager and felt that she was approachable. The two residents we spoke with said that the manager always speaks to us and we noted during our visit her communication skills with the residents and how they positively responded to her. The manager shows enthusiasm for her role, however she does lack some knowledge in relation to person centred care that is now being addressed by some specialist training form an external consultant to the home: this should result in better outcomes for the residents. We looked at accident records, these were good but the manager confirmed that they had not been audited so pattern of accidents and frequency had not been established. A sample of health and safety related information was checked, these records were in Care Homes for Older People Page 21 of 26 Evidence: good order; these included certificates for electrical and gas appliances and bath hoists. The fire records showed alarm testing and fire training. We looked at the records for formal supervision, these showed that the staff had been receiving supervision and discussion with two staff members confirmed this. We did note that the records needed to be extended to include discussion about professional development, the manager agreed that she would do this. The manager has been proactive in gathering information about the service the home offers, surveys have been sent to other professional agencies, residents and relatives; in some cases we could see what actions had been taken in view of the responses received. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 (2) People who use the service 09/07/2008 must have medicines prescribed on a prn (as required) basis given to them by staff only when clinically justified and this can be demonstrated by record keeping practices. Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 19 All people using the service must have an up to date detailed care plan. This will ensure that the people using the service receive person centred support that meets their needs. 31/08/2009 2 9 13 Care plans must provide clear guidance on the use of medicines prescribed for administration at the discretion of the staff. This will ensure the justification for their continued use. 31/08/2009 3 18 13 The manager must make sure that she completes training in safeguarding adults. This will ensure that all matters related to abuse are dealt with effectively. 30/09/2009 Care Homes for Older People Page 24 of 26 4 26 13 Chemicals that are 31/08/2009 hazardous to health must be stored in a locked cupboard. Residents must have an environment safe from hazardous risks. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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