Care Home: Ladybank

What the care home does well The management and staff team at Ladybank have all demonstrated a strongcommitment to working together to meet the requirements made at the last inspection and to improving the quality and consistency of the services provided to all service users. This work has resulted in a number of changes in the way the home runs and the way the staff work, all in a relatively short space of time. The management are congratulated on the way they have introduced these change and all staff at the home are congratulated on the way they have accepted these changes and then worked together as a team to implement the new systems and the new ways of working. What the care home could do better: In order to fully meet requirements made at the last key inspection the work on the new service users` guide needs to be completed by adding information on: the relevant qualifications and experience of the registered provider, manager and staff; the service users` views of the home; details of the total fee payable for the services provided by the home and the arrangements for the payment of that fee plus the arrangements in place for charging and paying for any additional services not included in the fee. The new system in place for quality assurance monitoring of risk assessments needs to be expanded and include a system for the manager to monitor that tasks, delegated to other members of the staff team for routine health and safety checks of the premises and equipment, are being carried out and that appropriate steps are taken to protect service users from any identified risk of harm or injury. In order to meet the recommendations made at the last key inspection, the new statement of terms and conditions document, provided to individual service users, needs to include details of: the room to be occupied; fees payable and by whom (service user, local or health authority, relative or another) plus additional services to be paid for over and above those included in the fees. The planned introduction of the new telephone system will enable callers to contact and speak to the registered manager of the home by only calling one number. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Ladybank 10a Ladybank Birch Hill Bracknell Berkshire RG12 7HA one star adequate service 18/09/2008 The quality rating for this care home is: The rating was made on: 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. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Denise Debieux Date: 0 4 0 2 2 0 0 9 Information about the care home Name of care home: Address: Ladybank 10a Ladybank Birch Hill Bracknell Berkshire RG12 7HA 01344459791 Telephone number: Fax number: Email address: Provider web address: ruth.halliday@bracknell-forest.gov.uk Name of registered provider(s): Name of registered manager (if applicable): Bracknell Forest Borough Council The registered provider is responsible for running the service care home 42 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 42 0 old age, not falling within any other category physical disability Conditions of registration: 0 42 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) Physical disability (PD). The maximum number of service users to be accommodated is 42. Date of last inspection 1 8 0 9 2 0 0 8 Care Homes for Older People Page 2 of 13 Brief description of the care home Ladybank incorporates long term residential and short term intermediate care resources on the same site. The home refers to the residential side as Ladybank and to the intermediate care side as The Bridgewell Centre. Ladybank residential side provides personal care and support to up to twenty three people aged 65 years and over, with the accommodation divided into three units. The Bridgewell Centre provides intermediate care to up to nineteen people aged 18 years and over, with the accommodation divided into two units. The home is situated close to South Hill Park, local shops and amenities are within a short walking distance. Care Homes for Older People Page 3 of 13 What we found: The purpose of this random inspection visit was to assess the homes compliance with requirements made at the last key inspection on the 17th and 18th September 2008. In order to assess compliance, the homes amended statement of purpose, amended service users guide, care plans, staff recruitment records, staff induction records and health and safety check sheets were all sampled. Other evidence was obtained from discussions with the registered manager for the home, the manager of the Bridgewell Centre and from discussions with service users and members of staff on duty. Choice of Home outcome group: At the last key inspection three requirements and one recommendation were made under this outcome group. Requirement number one required that the homes statement of purpose be reviewed. This requirement has been met. On the 5th January 2009, CSCI were provided with a copy of the homes revised statement of purpose. This document includes all items required of The Care Homes Regulations, is well written and easy to understand. The statement of purpose gives a clear picture of all services offered at the home, together with an easy to understand explanation of the organisation and structure for the whole service. Requirement number two required that the homes service users guide be reviewed. This requirement has been almost met. The manager has done as much as she can at this stage and the new service users guide covers the majority of items required. The new service users guide is, again, extremely well written and easy to understand, a copy has been provided to all service users. The manager is awaiting final pieces of information from Bracknell Forest Borough Council (i.e. information relating to fee breakdowns plus the results of service user surveys) before being able to meet this requirement in full. The manager advised the inspector that, as soon as the additional information is received, she will add it to the service users guide and produce the final version, copies will then be given to all service users, provided to new service users and a copy sent to CSCI to demonstrate full compliance with the requirement. Recommendation number one was for each service user to be provided with a statement of terms and conditions with the home. Recommendations are taken from the best practice described in the National Minimum Standards (NMS). In January 2009, CSCI were sent a copy of the draft terms and conditions document. The draft document was well set out and clearly described and explained the rights and obligations of both the home and the service user. Although not a requirement, the manager has worked hard towards meeting this recommendation and this work is almost complete. The manager is awaiting information relating to individual fee breakdowns, and needs to include costs (if any) of additional services provided or offered and also needs to add the room numbers for individual service users. Once these final details are added this recommendation will have been met. Care Homes for Older People Page 4 of 13 For all three documents described above the manager has obviously taken a lot of care in ensuring that the documents make clear the differences between the services provided on Ladybank (residential care side) and those provided by The Bridgewell Centre (intermediate care side). The inspector was advised that staff have been involved in the development of these documents and are aware of and understand the content. Together the documents clearly explain the organisational structure of the home, clarify lines of accountability and explain how the two, very different, sides of the home fit together under the one registration. This extensive work also contributes towards meeting one of the requirements made at the last inspection under the Management and Administration outcome group. The manager and all staff involved are congratulated on the success of this work. The final versions of the service users guide and the statement of terms and conditions will be assessed at the next key inspection. The third requirement made under this section was that the home must make sure that needs assessment are carried out for all service users admitted to the home. The concerns raised at that inspection only related to service users admitted to the Bridgewell Centre. This requirement has been met. Two files were sampled on the day of this inspection for two service users who had been very recently admitted to the Bridgewell Centre. Both files contained in depth and full needs assessments, which had been completed on the day of admission to the home. These assessments took into account and included external health professionals assessments that had been provided to the home prior to the person being admitted. Health and Personal Care outcome group: At the last key inspection one requirement was made under this outcome group, that the home must ensure that all service users have a written plan as to how their health, personal and social care needs will be met. The concerns raised at that inspection only related to service users admitted to the Bridgewell Centre. This requirement has been met. Two files were sampled on the day of this inspection for two service users who had been recently admitted to the Bridgewell Centre. The two care plans sampled were based on the pre admission assessments and had been drawn up shortly after each service users admission to the home and included appropriate risk assessments. It was positive to note that all staff involved in the care of the service users on Bridgewell Centre (e.g. care workers, registered nurses, physiotherapists, occupational therapists, speech and language therapists etc) participate in the drawing up, maintenance and documentation of the care plans. These care plans set out the actions which need to be taken by care staff and therapists to meet the health, personal and intermediate care needs of the service users, together with actions for staff to take to reduce any identified risks. The daily notes demonstrated that any changes or new concerns are promptly acted upon and information added to the care plan without delay. Both care plans had been signed by the service users to demonstrate their involvement and agreement to the contents. The manager of the Bridgewell Centre also explained that the care plans in the Bridgewell Centre are now kept in each service users room so that service users are fully involved in the planning and maintenance of their plan. Two service users spoken Care Homes for Older People Page 5 of 13 with confirmed that they felt fully involved in the care planning process and that they also felt that the staff asked for and consulted with them when making changes or amendments. The registered manager explained that she is currently consulting with the service users in the Ladybank residential side, with a view to adopting the same system there. Complaints and Protection outcome group: At the last key inspection one requirement was made under this outcome group, that the home must ensure that all staff employed to work at the home understand and comply with the homes whistle blowing policy and the procedures in place for safeguarding adults. This requirement has been met. Prompt action was taken to address this requirement, within seven days of the last inspection all staff had been given copies of the homes whistle blowing policy as a reminder and had been required to sign to say they had read and understood the contents. Since then, with the support and involvement of the safeguarding coordinator for Bracknell Forest Council, all staff have attended refresher safeguarding training. This refresher training is also included in all staff members personal development plans. Whistle blowing and safeguarding training is included in any new staffs induction programme. In addition, safeguarding adults is now a mandatory agenda item at the staff meetings held every two months at the home. The manager advised that this gives the staff the opportunity to raise any general questions they may have and makes sure that the training staff have received is reinforced. A copy of the safeguarding adults flow charts, from the Bracknell Forest safeguarding procedure, has been laminated and is kept by the entrance to the home and is easily accessible to all staff, service users and visitors. Staffing outcome group: At the last key inspection three requirements were made under this outcome group relating to staff recruitment and induction training. One requirement was that all people involved in recruitment must be aware of and adhere to the requirements of the Care Homes Regulations. This requirement has been met. The file of the one member of staff recruited since the last inspection was sampled and found to be in order. The manager had personally ensured that all required information had been obtained prior to offering the person a position at the home and demonstrated a good understanding of the regulations and her own responsibility in the procedure. The second requirement was that all staff files for staff employed since 26 July 2004 should be checked to ensure that they contained all the correct information and documents. This requirement has been met. One of the files that had been sampled and found to be incorrect at the last inspection was re sampled on this visit. Evidence was seen that staff from the human resources department of Bracknell Forest Council had checked the file and the manager had then carried out her own check, with the required information, where possible, now in place. The manager confirmed that all files for staff employed since 2004 had been checked Care Homes for Older People Page 6 of 13 and discrepancies rectified. However, the evidence seen indicated that there may be some areas of the regulations that need to be discussed and clarified with staff involved in recruitment, e.g. a clearer method of establishing that they have obtained a full employment history and that any gaps are explained in writing; clear guidance needs to be developed on what steps staff are expected to take when trying to verify applicants reasons for leaving previous employment working with vulnerable adults and actions staff should take to attempt to obtain references from the last place an applicant worked with vulnerable adults, especially when this may have been a number of years in the past. The third requirement made under this outcome group was that the home must obtain confirmation, in writing, from employers other than the registered provider (e.g. agency staff) that the agency has obtained all the required information and documents set out in the Care Homes Regulations. This requirement has been met. Following the last inspection, the situation regarding details of staff recruitment for staff employed directly by the local PCT but working at the Bridgewell Centre was clarified with the legal department of CSCI. It was determined that regulations require that the home should hold the same information for these staff as they do for agency staff, as they are employed by someone other than the registered provider. The home now hold detailed information sheets for all agency and PCT staff that are working, or have worked at the home. The agencies and PCT have provided written confirmation for each individual, confirming that they have carried out all required checks and obtained all the required documentation. These sheets were sampled and all were seen to be in order. Each separate sheet also contained a recent photograph of the person in question and the forms had been signed by the person in charge of the home at the time of the persons first shift to evidence that they had checked the form and the photograph. The manager also advised that all employers, other than the registered provider, had been advised that no person will be allowed to work at the home without this written confirmation being in place. Management and Administration outcome group: At the last key inspection four requirements and one recommendation were made under this outcome group. The first requirement was that the provider needed to review and clarify the organisation and management of the home. This requirement has been met. Following the last inspection the provider, Bracknell Forest Borough Council, worked with other stakeholders involved, (e.g. East Berkshire PCT) and reviewed, clarified and agreed the organisational structure of the home. This structure is now described in the new statement of purpose and service users guide as discussed earlier in this report. Staff spoken with during this visit had a good understanding of how the home is run and managed and it was reported that there is now more integration between the two different staff groups. The second requirement made at the last inspection under this outcome group was that a quality assurance and monitoring system must be implemented to cover both sides of the home. The manager described the changes that have been made to the previous systems. The practice of asking all service users admitted to the Bridgewell Centre to complete an end of stay survey will continue, with the forms being returned Care Homes for Older People Page 7 of 13 to the provider so that the quality of the intermediate care services can be monitored and survey forms for all service users and visitors will continue to be available at the entrance to the home. The manager has now developed an additional survey form that will be used once a year to give the manager a snapshot view of the whole home. The plan is that on one day (planned for this July) all service users resident at the home will be asked to complete the survey form. The manager will then correlate all the forms returned and develop an action plan to address any areas for improvement that may be identified. The manager also explained that she hopes to be able to identify if service users receiving care on one side, report a different experience from those receiving care on the other side, i.e. differences between the residential care side and the intermediate care side. This requirement has been met and the inspector will sample the correlation of the surveys and the resultant action plan at the next key inspection. The third requirement made at the last inspection under this outcome group was for the home to implement a system to monitor that staff take appropriate action when any risks to the health, safety and welfare of service users are identified. This requirement was made as a result of findings at the last inspection: risk assessments seen in care plans on the Bridgewell Centre identified risks but no actions to reduce that risk being documented, plus some health and safety checklists seen e.g. fridge temperatures on the units had been recorded daily but, where the temperatures were too high, no action had been taken. The manager advised that, following the last inspection, the purpose and process of risk assessment had been reviewed with all staff. Individual risk assessments for service users on the Bridgewell Centre are now monitored by the lead nurse on that side as part of the ongoing monitoring of care plans. Fridge temperature checklists on two of the units were sampled during this visit and they were seen to be up to date with all recorded temperatures being within acceptable limits. However, at present there is no system in place for the manager to sample, monitor and document that routine health and safety checks of the premises and equipment are being carried out and that action is taken when risks are identified. This requirement has been mostly met in that risk assessments specific to individual service users are being closely monitored. But the requirement will be left open and reassessed at the next key inspection when a system has been introduced that enables the manager to monitor that tasks delegated to other members of the staff team for routine health and safety checks of the premises and equipment are being carried out, can be sampled. At the last inspection it was identified that a number of incidents that should have been notified to CSCI, had not been and a requirement was made. The manager advised that she had discussed this with all staff on both sides of the home. Since that time notifications have been sent by the home to CSCI, as required, and this requirement has been met. At the last inspection a recommendation was made for the home to review the telephone system, which currently has two unconnected telephone numbers for the different sides. The manager advised that work to introduce a new, integrated system is underway and it is expected this work will be completed later this year. What the care home does well: The management and staff team at Ladybank have all demonstrated a strong Care Homes for Older People Page 8 of 13 commitment to working together to meet the requirements made at the last inspection and to improving the quality and consistency of the services provided to all service users. This work has resulted in a number of changes in the way the home runs and the way the staff work, all in a relatively short space of time. The management are congratulated on the way they have introduced these change and all staff at the home are congratulated on the way they have accepted these changes and then worked together as a team to implement the new systems and the new ways of working. 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 2. Care Homes for Older People Page 9 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 1 5 The registered person must 18/12/2008 produce a service users guide that reflects the entire service provided at Ladybank, including all matters listed in Regulation 5 (1) of the Care Homes Regulations 2001, as amended by The care Standards Act 2000 (Establishments and Agencies) (Miscellaneous Amendments) Regulations 2006. In order that prospective service users have the information they need to make an informed choice about moving to the home and that existing service users are aware of the services provided by Ladybank. 2 38 13 The registered person must 18/10/2008 implement a monitoring system for the whole home to ensure that any risks identified to the health, safety and welfare of the service users are promptly addressed. (This requirement also refers to Standards 7 and 8.) In order that the health, safety and welfare of service Care Homes for Older People Page 10 of 13 users is promoted and protected. Care Homes for Older People Page 11 of 13 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 1 2 It is recommended that each service user is provided with a statement of terms and conditions with the home, as set out in national minimum standard 2. (Brought forward from key inspection of 18/09/08.) It is recommended that the provider reviews the telephone system at the home to enable calls to be directed to the registered manager, whichever telephone number is dialled by the caller. (Brought forward from key inspection of 18/09/08.) 2 32 Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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