Inspection on 11/11/05 for Bolealler House

This inspection was carried out on 11th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bolealler House 09/09/09

Bolealler House 07/08/07

Bolealler House 18/08/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Honeybourne House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Bolealler House Bolealler House Westcott Cullompton Devon EX15 1RJ Lead Inspector Vivien Stephens Unannounced Inspection 11th November 2005 10:30 Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bolealler House Address Bolealler House Westcott Cullompton Devon EX15 1RJ 01884 38275 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) Bolealler House Limited Anne Maddox Care Home 20 Category(ies) of Learning disability (20), Learning disability over registration, with number 65 years of age (20), Mental disorder, excluding of places learning disability or dementia (20), Mental Disorder, excluding learning disability or dementia - over 65 years of age (20), Old age, not falling within any other category (20) Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Manager must obtain NVQ level 4 and the Registered Managers’ Award by 1st January 2008 25th May 2005 Date of last inspection Brief Description of the Service: Bolealler House is owned by Bolealler House Ltd, a subsidiary of Allied Care Ltd. The property consists of a large detached country house with a converted stable block and a further extension, called Angels. It is situated in a rural area between Broadclyst and Cullompton. The main property is a period style house retaining many original and interesting features. The recent extension, Angels, is a stylish and modern house that operates separately from the main house, with its own kitchen, lounge, dining room and bedrooms. There are large grounds and lovely views of the surrounding countryside from many of the rooms. The home provides support and personal care for 20 adults with a learning disability or a mental health problem.The home has transport to enable service users to use local facilities. Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6 hours. Anne Maddox, Manager, was present throughout the day and Bill Marlowe; Area Manager for Allied Care Ltd was present for the first hour of the inspection. This was the first inspection following the sale of the home. The main focus was to find out if there have been any issues arising as a result of the change of ownership. Most of the core standards were covered at the last inspection with the exception of standard 23 – protection, and standard 35 – staff training, which were covered during this inspection. New recording systems, policies and procedures were sampled and discussed. The administration of the midday medications was witnessed. During the inspection discussions were held with most of the residents. The midday meal was shared with residents and staff. A tour of the communal areas of the home took place, and some bedrooms were. Discussions were held with staff on duty that day. What the service does well: Residents talked positively about their experiences at Bolealler House. Staff and residents were welcoming, open and friendly. Good care planning systems are in place. New care plans are slowly being introduced that are written by, or in the words of the resident. These will build upon the information already held in the existing care plans, and will ensure staff help the residents work towards their future goals. There is a lively atmosphere within the home. Residents go out and about in the community every day. Some have jobs, attend courses or clubs, or follow their chosen hobbies and leisure interests. Staff support them to keep in contact with friends and families. They are also supported to maintain relationships. Staff take care to ensure medicines are administered safely. The home has good systems in place to ensure residents feel safe, and to ensure concerns and complaints are listened to and acted upon appropriately Staff have received a wide range of training in the last year. They were confident, caring and demonstrated a good understanding of the needs of the residents. Good recruitment procedures are in place. Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not covered during this inspection. See last inspection report for further information. Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 Good care planning systems are in place. The home has acted sensibly in adopting a slow and careful introduction of a new care planning system. The staff respect the right of residents to make decisions about all aspects of their lives. EVIDENCE: The existing care plans have been built up and improved over a number of years and contain a wide range of relevant information. A new care planning system provided by Allied Care Ltd is slowly being introduced. These are called a ‘lifestyle plan’ and are very much centred on the resident. They will be completed by the resident, or written on their behalf, and in their words. This work is likely to take some time, and in the meantime the existing care plans will continue to be used and updated until all information is transferred to the new system. The new care plans look at the residents’ plans and aspirations for the future, and show the agreements that have been reached on how to help them achieve their goals. During the inspection residents talked about their daily lives and gave some examples of decisions they have made, both individually and as a group. Staff Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 10 were seen giving advice and support on a number of issues. The manager gave some examples of the guidance that has been sought from other professionals where freedom and choice may have to be restricted. Residents have been consulted on many aspects of the daily life at the home, including menus, holidays and activities. Regular Residents’ Meetings are held. The new owners plan to introduce a number of changes, including a comprehensive ‘quality assurance’ system, that will entail greater involvement by the residents in the day-to-day running of the home. Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 17 Residents have opportunities to lead fulfilling lives. They are encouraged and enabled to meet friends and family, have relationships and participate in the local community. Staff respect residents’ rights and choices, and encourage independent living skills. The home provides a varied menu that has been drawn up through consultation with the residents. It is recommended that specialist advice be sought on how to further encourage healthy eating. EVIDENCE: Residents talked about some of the things they enjoy doing each day. They talked about their jobs, clubs, college courses, and hobbies. During the day some went out for a walk, while others went shopping or helped around the house. Some talked about their progress since moving into the home and how they looked forward to living more independently in the future. Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 12 There were a number of examples of how residents participate in the local community. Transport is provided by the home. Residents talked about their families and friends, and how they keep in touch, either by visits or by telephone. Some have their own mobile phones. Relationships are encouraged and enabled in various ways, including the provision of a self-contained flat for one couple. The inspectors sat and shared the midday meal with the service users in the main house. The atmosphere around the dining table was relaxed and friendly with everyone talking about the things they had been doing or planned to do. The meal was fish, chips and peas with an alternative of fish cakes, chips and peas. Service users were offered yoghurt for afters. A bowl of fresh fruit is normally left on the dining room table for everyone to help themselves. Staff and residents talked about the consultation process for the menus. Residents living in the accommodation named Angels have their meals cooked and served in their own kitchen/dining room. The home encourages independence with the provision of kettles and fridges in some bedrooms. There is also a self-contained apartment within the home complex. The subject of healthy diets was discussed with the manager. At times the staff find it difficult to balance the rights of residents who are more independent and can buy their own foods, including crisps and sweets. Anne Maddox said they regularly seek advice from a nutritionist or district nurses on specific dietary needs and so it was recommended they also seek advice on ways of encouraging residents to eat a healthy balanced diet. Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 The home operates a safe system of storage and administration of medicines. Policies and procedures are clear and easy to follow, but should be enlarged to incorporate all areas set out in guidance provided by the Commission. The security of medicines that have to be refrigerated should be improved. EVIDENCE: The mid-day administration of medicines was witnessed. The home’s policy is for two staff to work together when medicines are handled or administered, each checking that the process has been carried out safely. Staff who administer medicines have received training provided by the pharmacy. The home uses a monitored dosage system. Records were well maintained. The bulk of the medicines were stored securely in a steel cabinet within a locked cupboard. Some excess medicines have been stored in the refrigerator in the food store. This room is locked when not in use but this is away from the main medicines store and the medicines are not securely locked inside the refrigerator. It is therefore recommended that a medicines refrigerator be provided in order to ensure secure storage at all times. The policies and procedures for medicine administration were kept in the main office. It is recommended that a copy be kept close to the medicines cupboard so that staff have quick and easy access. A new policy has recently been Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 14 introduced. While this covers many aspects of the administration process, some areas were missed. Guidance drawn up by the Commission has been forwarded to the home and it is recommended that the home follow this to revise their policy on the administration of medicines. Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The home has good systems in place to ensure residents feel safe, and to ensure concerns and complaints are listened to and acted upon appropriately. Residents are protected from abuse, neglect or harm by comprehensive policies and procedures. A few additions are recommended to clarify some procedures. The home should provide policies and procedures in alternative formats for those residents who may have difficulties with reading. EVIDENCE: Residents talked about who they would speak to if they had any concerns or complaints. They were happy with the systems in place in the home to deal with concerns and complaints. Staff and residents talked about their confidence in the new management of the home. No complaints have been received about the home by the Commission since the last inspection. Most of the staff have attended courses on the protection of vulnerable adults. The new owners are gradually introducing a comprehensive range of policies and procedures on all aspects of the management of the home. These are being given to staff in stages, and are discussed in staff meetings and supervision to ensure staff understand them. Policies relating to protection were forwarded to the Commission following this inspection. These included policies on – * Accident and incident reporting * Protection and prevention of abuse Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 16 * * * * Reporting of bad practice and whistle blowing Dealing with incidents of self harm/abuse Compliments, comments, suggestions and complaints Service users’ finances These policies are detailed and cover almost every situation and action required. A few minor suggestions and recommendations have been made for further areas to be covered – these have been set out in a separate letter. One area not covered was when staff should contact the police, and the procedures for either a police or internal investigation – this is recommended. The policies are written in a formal style that may be difficult for some residents to read and understand. Anne Maddox talked about how she and the staff have read and explained some of the policies to the residents, including the complaints procedure. The possibility of providing procedures (especially the complaints procedure) in other formats was discussed. It was recommended that the home consider alternative formats for those who have difficulty with reading. Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 Residents live in a comfortable and homely environment. The new owners are in the process of making significant improvements to the property, and the residents and staff are delighted with results so far. It is recommended that a designated smoking area be provided. EVIDENCE: It was highlighted at the last inspection that some of the communal areas were beginning to look tired and shabby. The new owners have begun a programme of upgrading and improving the home. At the time of this inspection the main entrance hall and staircase were being decorated and a new carpet has been ordered. The converted stables were also being redecorated, new carpets and furnishings ordered, the bathroom and kitchen have been upgraded, and new UPVC windows and doors ordered. The staff and residents talked about their pleasure in seeing the home brightened up. Some of the bedrooms were seen during the inspection. These have been highly personalised and appeared comfortable and homely. Most are in good decorative order but a few are showing signs of wear and tear. Anne Maddox said that there is a rolling programme for the decoration of the bedrooms and some will be decorated in the near future. Some bedrooms have tea and coffee Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 18 making facilities and refrigerators enabling the residents to lead a more independent lifestyle. Bathrooms in the converted stables and Angels accommodation are bright and modern. There are plans to upgrade some of the bathroom and toilet facilities in the main house to ensure all of the facilities are of the same high standard. All of the lounges are comfortably furnished and decorated. There are plans to provide a new office and to convert the present office into another lounge and activity room. There are also plans to upgrade and redecorate the dining room in the main house. Smoking is currently permitted in all areas of the house, and as a result nonsmoking residents may find themselves sitting in a smoky atmosphere. It is recommended that a designated area be provided for smoking. Two maintenance staff have been employed. They have been carrying out much of the redecoration and improvements as well as ensuring the ongoing maintenance of the house and gardens. Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 The staff team are positive, effective and well trained. Residents are safeguarded by good recruitment procedures. EVIDENCE: At the time of this inspection the manager was on duty plus six care staff. Staff rotas show that there are normally six or seven care staff on duty each morning and five or six staff each afternoon and evening, plus the manager. At night there are 2 staff on duty. In addition there are 2 maintenance staff and an administrator. This provided sufficient staff to work either individually or with small groups of residents, and also to ensure daily routines were carried out. A copy of the staff training record was provided during the inspection. 10 staff are currently undertaking NVQ’s, 3 staff have completed NVQ’s and 1 staff holds the City and Guilds Community Care part 1. In the last year a wide range of training courses have been provided, including - asthma, diabetes, epilepsy, strokes, falls and fractures, sexuality and relationships, first aid, food hygiene, health and safety, infection control, administration of medicines, protection of vulnerable adults, fire safety, moving and handling, and AVCE Health and Social Care courses. Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 20 The files were seen of those staff recruited since the last inspection. References and checks had been carried out prior to appointment and all required recruitment procedures followed. Staff talked positively about their work. There is a stable staff team with low staff turnover. They have welcomed the training opportunities provided by the new owners and looked forward to the future. Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38, 39, 40, 41 The home is managed effectively and efficiently. Comprehensive policies and procedures are being introduced. A new quality assurance system will ensure that everyone is consulted and involved in all aspects of the home, and high standard of facilities and services are maintained. There is an open and positive atmosphere within the home. Good recording systems are in place. EVIDENCE: Anne Maddox is currently undertaking NVQ level 4 and the Registered Managers’ Award. She has had a number of years of relevant experience. Residents and staff talked positively about the new owners and management of the home Allied Care Ltd own a number of other homes across the country and have built up their management systems, policies and procedures based on their Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 22 experience in caring for adults with disabilities. These systems are being introduced gradually to Bolealler House. The Area Manager explained his role in supporting and overseeing the management of the home. He visits the home on a regular basis and is just starting to complete Regulation 26 reports that will be forwarded to the Commission each month. He also talked about the quality assurance systems that are about to be introduced. The company have drawn up comprehensive procedures to check and improve the quality of the services they provide, and employ staff specialising in this subject. Records seen during this inspection included – - Administration of medicines - Care planning systems - Staff recruitment files - Staff training records - Staff rotas - Menus - Policies and procedures These records were found to be well maintained and in good order. Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X x Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 X X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 2 X x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 x 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score x 3 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bolealler House Score x x 2 x Standard No 37 38 39 40 41 42 43 Score x 3 3 3 3 X x DS0000064992.V266741.R01.S.doc Version 5.0 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA17 YA20 YA20 YA23 Good Practice Recommendations The home should seek further advice on how to promote healthy eating. The policy on the administration of medicines should be enlarged to incorporate all areas set out in guidance provided by the Commission. The security of medicines that have to be refrigerated should be improved. The policy on the protection of vulnerable adults should be enlarged to explain when staff should contact the police, and explain when an internal investigation should be carried out. The home should provide policies and procedures in alternative formats for those residents who may have difficulties with reading. A designated smoking area should be provided 5 6 YA23 YA28 Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bolealler House DS0000064992.V266741.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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