Care Home: Bushey House

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What the care home does well We carried out a Key Inspection in June of this year (2009), at that inspection we found areas of concerns in relation to the care of the residents and Bushey House was given a 0 star rating. On this occasion we noted an improvement in all aspects of the service and the care of the residents. We saw records that showed us that prospective residents were given a full assessment prior to admission to the home. They were only admitted if the home could meet their needs. At the last inspection complaints were not being responded to, this is no longer the case. Outstanding complaints that were awaiting a reply or an investigation had been addressed. We found the environment, including the extensive grounds, well maintained. We spoke with staff, who at the time of the last inspection told us that they had concerns about the welfare of the residents, on this occasion they told us that there was an improvement and that they no longer held those concerns. What has improved since the last inspection? All aspects of the care of the residents and the running of the home has improved in the past six months. At that inspection we left a number of immediate requirements, all of these had been met. We also left other requirements that have either been met or the home has made good progress in meeting them. The home has been through a period of intense change where a management team addressed the issues raised at the last inspection. As already stated the home has now appointed a manager who started on 1 September 2009. It is too early to make a judgment on her performance, however people we spoke with regarding her management of the home, including residents, staff and visitors to the home were very complementary about her performance and told us that they found her to be knowledgeable and approachable. Prior to starting the inspection visit we spent time with the new Manager, we asked her about the care of the people who live in the home. She gave us her priorities for ensuring that the people who live in the home have good care. She was able to tell us the home`s strengths and area where more improvement is needed. She had plans in place to meet the areas that needed improvement. We noted that staff morale was much better that at the last inspection in May 2009. Now there are management systems in place to ensure staff now know what their responsibilities are to the residents and how to ensure that the resident`s care is carried out in a person centered manner. By that we mean that care is administered in a manner that meets the wishes of the resident. Staffing levels have improved and if a staff member is off sick they are replaced on that shift. What the care home could do better: As already stated the home has made good progress in the past six months, the Manager needs to build on these improvement and ensure that in future good practice is embedded in the care of the residents of this home. Key inspection report Care homes for older people Name: Address: Bushey House 57-59 High Street Bushey Hertfordshire WD23 1QN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marian Byrne     Date: 0 6 1 1 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 22 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. 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 Care Homes for Older People Page 3 of 22 Information about the care home Name of care home: Address: Bushey House 57-59 High Street Bushey Hertfordshire WD23 1QN 02084218844 01089509387 linda.simpson@barchester.com www.barchester.com Barchester Healthcare Homes Ltd care home 60 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) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The home may accommodate three older people who require personal care. They may accommodate 60 older people who need general nursing care and convalescent care. This home may accommodate 10 persons aged 50 years or more with a physical disability who require nursing care. Date of last inspection Brief description of the care home The Bushey House Beaumont is a 19th Century Grade II listed mansion with a purpose built extension in keeping with the original house. The view over a lake and parkland can be seen from the library, dining room and patio. The home is spacious and furnished and decorated to a high standard in keeping with the period style of the building. Individual rooms have en suite facilities and in addition to these there are assisted bathing and toilet facilities to meet the needs of elderly and physically disabled residents. The home is close to the local amenities of Bushey High Street. Care Homes for Older People Page 4 of 22 Over 65 60 60 0 0 1 7 0 6 2 0 0 9 Brief description of the care home Details about the home are contained in the Service User Guide, brochure and welcome pack that are available on request from the manager together with a copy of CSCI inspection reports. Details of current fees can be obtained direct from the provider. Care Homes for Older People Page 5 of 22 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: one star adequate 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 inspection was carried out by two inspectors over a one day period. We looked at records pertaining to the care of the residents, the recruitment of staff and the training of staff. We spoke to residents, visitors to the home and staff who work in the home. We spent time with the new manager who was appointed on 1 September 2009. Care Homes for Older People Page 6 of 22 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 Care Homes for Older People Page 7 of 22 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. Care Homes for Older People Page 8 of 22 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 9 of 22 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. People who are admitted to this home can be sure that their needs will be assessed and that their needs will be reviewed regularly to enable the home to ensure the best possible care for the resident. Evidence: We looked at the admission process and found that the records contained good detail on the person to be admitted. We saw evidence that showed us that reviews of the persons needs take place. Care Homes for Older People Page 10 of 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home can be sure that their health and personal care will be administered in a manner that promotes their health, dignity and welfare. Evidence: We looked at the care plans of three residents and found them to contain good information and good instructions to staff on how to care for the residents. We found the care plans to be person centered, by this we mean that they were drawn up to meet the needs of the residents and give detail on how the resident wants their care administered. There was detail of when the person like to get up in the morning, what they like for breakfast and if they like breakfast in their rooms or in the dining room. All residents are registered with a local GP. There was a auditing system in place to ensure that the care plans always reflect the changing needs of the residents. We were told that two residents had pressure area care and that they were being attended to by a pressure viability nurse to ensure optimum care and good health. We found that the storage, administration and recording of residents medication was, with one exception in order. The anomaly was corrected within 48 hours of the site visit. Care Homes for Older People Page 11 of 22 Evidence: We saw staff interact with residents in a manner that promoted their dignity and independence. The residents we spoke with told us that staff were kind and caring and that they were gentle when administrating to their care needs. Care Homes for Older People Page 12 of 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most of the people who live in this home can be sure that their social needs will be recognised and efforts will be made to ensure that they are met. Evidence: Visitors are welcomed to the home at all reasonable times. On the day of the site visit we noted a constant stream of visitors to the home. Visitors are welcome to join their friends or relatives at meal times so that they can enjoy a meal together. Residents who are able to and want to are taken out of the home regularly to enjoy local attractions. There are people in the home dedicated to ensuring the residents have access to useful occupation. This includes one to one time for those who are unable to partake in group activities. We tasted the food and found it to be tasty and served at an appropriate temperature. We observed staff assist residents with eating in a manner that promoted their dignity. Residents told us that they enjoy the food and if there is a menu item that is not to their taste they will be provided with a choice. A requirement was left at the last inspection regarding the poor experience some residents have while waiting for their meals to be served. We noted an improvement in this, the manager also told us of the improvements that she has planned for the continued improvement of dining experience of the residents experience. Care Homes for Older People Page 13 of 22 Evidence: All the residents had been invited to a recent fire work display in the garden of the home. Those who wanted to go outside were wrapped up warm and staff sat with them throughout the display. They told us that they enjoyed it very much. We were told by some residents that they hadnt seen a fire work display for many years and appreciated the opportunity to partake in the event. We noted that a high number of residents congregate in the main dining room, there are not always objects of interest or comfort to enable the residents to have stimulation. Some staff are still walking through this room without making eye contact or any connection with the people who are sitting there. We saw some residents trying to catch the eye of staff and failing. We discussed this with the manager at the end of the inspection, she resolved to ensure that the rooms furniture was re-arranged to stop staff rushing through. Care Homes for Older People Page 14 of 22 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. People who use the service can be sure that their complaints will be listened to and addressed. Residents can be sure that staff are aware of what constitutes abuse and that they will act on any incidents that could result in any abuse to the residents. Evidence: The new manager has made very good progress in addressing complaints that were outstanding when she assumed her present position. She has worked through the back log and has responded to all of them. Visitors we spoke with told us that they now are gaining confidence that their complaints will be listened to and acted on if necessary. Staff told us that they were more confident about approaching the new manager if they have worries about the care of the residents. All staff spoken with were aware of Safeguarding Adults issues and what to do if there was an incident of abuse. Care Homes for Older People Page 15 of 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home can be sure the environment will meet their needs. Evidence: On the day of the site visit the home was clean, bright, fresh and odour free. All bed rooms were decorated to reflect the taste of the resident living there. The Manger is aware that many of the sitting rooms throughout the home are seldom used and is planning to address this as it would give residents more choice on where to sit and relax. Care Homes for Older People Page 16 of 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home can be sure that staff are appropriately recruited and their training needs have been recognised to ensure that staff give the best care to the residents. Evidence: At this site visit we found staff morale to be much better than at our last inspection. They told us that the new manager seems very fair and very knowledgeable. We spoke with staff who told us that they had worried in the past regarding the care of the residents, this time they told us that they no longer have those worries. We found staff to be recruited appropriately and that updating training needs of the staff has been given a high priority. Staff told us that there is sufficient staff on duty and that is someone is ill or on holidays they are replaced. There are still some issues to be resolved however the manager is aware of these and is working to ensure that the residents needs and wishes are at the forefront of running the home. Staff are working to a rota, we noted that very long hours we observed staff to be working at the last inspection has been replace with a planned rota that allows staff reasonable time off. We noted the dedication of staff and wish to provide the best possible care for the residents, however as already stated we noted staff rushing through the dining room, where many of the residents meet, without making eye contact or greeting the residents. This gives the room an air of a thoroughfare rather than a room for relaxing in. The Manager is aware of this and has plans to address it. Care Homes for Older People Page 17 of 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home can be sure that the Provider is serious in ensuring that the home is now well managed and run for their benefit. Evidence: The home has been through six months of extreme change without a permanent manager to lead, assist and guide staff. The Manager at the time of the last inspection is no longer is post. A team of managers was put into the home to make improvements and to meet the requirement left at the last inspection. A new manager was appointed on the 1 September 2009. This management team have made many changes that have resulted in the improvement of the life of the residents. The new manager is in the process of registering with this Commission. Prior to starting the inspection visit the Manager was able to bring us up to date of changes that occurred in the home since the last inspection. We found what she told us to be reflected in our findings. Staff have told us that she is approachable and knowledgeable. They told us that any issues they bring to her are addressed in the best interests of the people who live in the home. Staff are now being managed and are working reasonable hours. Care Homes for Older People Page 18 of 22 Evidence: They have started to have regular supervision. Improvements have been made in the home. However it is too soon to make a valid and lasting judgment on the managers capability in the short time she has been in post. All the Health and Safety checks are up to date. There are two outstanding requirement, however we note that good progress has been made to meet these. Care Homes for Older People Page 19 of 22 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 30 18 The Registered Manager must ensure that all residents are kept safe through up to date staff training. You must do this because staff must be trained to deliver person center care. 30/09/2009 2 32 12 The Registered Providers 31/07/2009 must ensure that the home is managed in a manner that promotes openness and empowers staff and residents to express their views and opinions without fear. You must do this because residents and staff must feel free to express options and have those opinions listened to. Care Homes for Older People Page 20 of 22 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 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 21 of 22 Helpline: 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. Care Homes for Older People Page 22 of 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!