CARE HOMES FOR OLDER PEOPLE
Bolton Hall Care Home Carrhead Lane Bolton On Dearne Rotherham S63 8DA Lead Inspector
Steve Vessey Unannounced 14 September 2005 09:00am
th 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 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 Older People. 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. Bolton Hall Care Home J55 S6473 Bolton Hall V247498 140905 UI Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Bolton Hall Care Home Address Carrhead Lane Bolton On Dearne Rotherham S63 8DA 01709 881456 01709 891731 Not known Yorkshire Parkcare Company Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Pat Davies N - Care home with nursing 80 Category(ies) of OP Old age (80) registration, with number of places Bolton Hall Care Home J55 S6473 Bolton Hall V247498 140905 UI Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. All 80 OP beds may instead be used in the category PD, Physical Disability for people aged 60 years and above, whose disability is as a result of the ageing process. Date of last inspection 8th March 2005 Brief Description of the Service: Bolton Hall is a purpose built care home that accomodates up to 80 service users. The home provides both personal care and nursing care. There is a large car park. The home is a short distance from public transport and shops, post office and pub etc. Extensive garden areas surround the home. Bolton Hall Care Home J55 S6473 Bolton Hall V247498 140905 UI Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over approximately five and a half hours from 09:50 to 15:10 The inspection process included a partial inspection of the premises, inspection of a sample of records and policies, discussions with staff, residents and relatives and observation of staff carrying out their duties. The majority of residents and staff were seen during the inspection and the inspector had the opportunity to speak to eight staff, six residents and relatives in some detail. What the service does well: What has improved since the last inspection?
The redecoration of the corridors, the replacement of the ground floor corridor carpet and bathroom flooring and the refurbishment of the shower room had improved the environment for residents. The safety of the environment had improved as there were no hazardous substances left unattended around the home, clear access to fire fighting equipment was maintained, suitable waste bins for the disposal of incontinence products had been provided and the staff room was closed when not in use. Residents were protected as the home had a copy of the Barnsley local authority adult protection procedures and staff had attended adult protection training. Bolton Hall Care Home J55 S6473 Bolton Hall V247498 140905 UI Stage 4.doc Version 1.40 Page 6 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. Bolton Hall Care Home J55 S6473 Bolton Hall V247498 140905 UI Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Bolton Hall Care Home J55 S6473 Bolton Hall V247498 140905 UI Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Resident’s needs had been assessed prior to admission to the home. EVIDENCE: Five care plans included a full assessment of the needs of the residents carried out by staff at the home. Some residents stated that someone from the home visited them before their admission. Bolton Hall Care Home J55 S6473 Bolton Hall V247498 140905 UI Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Residents and their representatives had been involved in formulating and reviewing of some care plans, which reflected the assessed needs of residents. Resident’s health care needs were in the main met, however including a nutritional risk assessment in all care plans would improve this. Medication was well managed. Residents are treated with respect and their privacy is maintained. Bolton Hall Care Home J55 S6473 Bolton Hall V247498 140905 UI Stage 4.doc Version 1.40 Page 10 EVIDENCE: Five care plans included detailed information as to the actions required by staff to meet the needs of individual residents and were reviewed. Some care plans included risk assessments for the administration of, the development of pressure areas and moving and handling and nutrition. The manager stated that risk assessments were included in care plans where an issue with had been identified. Residents or their relatives had signed some risk assessments and care plans to show that they had been consulted. Residents seen were well cared for, they were clean, their hair and nails had been attended to and male residents were shaved. Residents stated that the staff looked after them well and they were able to remain with their own GP when they moved into the home. There were records of medication coming into the home and to support the safe disposal of medication. There were medication administration records for residents, which were completed appropriately, maintaining resident’s health safety and welfare. In the main medication was administered by nursing staff, however senior care staff had been appropriately trained to administer medication to residents receiving personal care. Medication, including controlled drugs was stored safely. Care staff were able to describe how they promote privacy and dignity when providing care for residents, nursing staff described how they monitored care delivery to ensure the privacy and dignity of residents is maintained. Bolton Hall Care Home J55 S6473 Bolton Hall V247498 140905 UI Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 and 15 Relatives are encouraged to visit and be involved in resident care. Residents receive a choice of food, which is of good quality and can choose where they eat. Residents were assisted to eat in a discreet and sensitive way. EVIDENCE: Relatives stated that the staff are friendly, welcoming and approachable. Residents stated that they could receive visitors in communal areas or in their rooms. Residents stated that they could choose what they eat. Residents were eating in pleasant surroundings and staff assisting residents to eat did so in a discreet and sensitive manner. In the main residents were happy with the quality of the food, however some residents stated that they did not get enough to eat. Staff stated that if residents asked they could have extra food. Bolton Hall Care Home J55 S6473 Bolton Hall V247498 140905 UI Stage 4.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Residents and relatives were aware how to complain and thought that their complaints would be listened to and dealt with. Some staff were aware of the policies and procedures in place to protect residents from abuse and had received training. The protection of residents would improve if senior staff were more confident in their knowledge of the local authority adult protection procedures. EVIDENCE: There was a complaints record in place, which included all the appropriate information. Staff and relatives were aware of how to complain and stated that they thought staff would listen and try and resolve any issues. No recent complaints were recorded The Barnsley Local Authority Adult Protection procedures were in the nursing office. Staff had received adult protection training and were aware of the procedures to follow if they suspected abuse had occurred. Some senior staff stated that were not fully aware of the local authority adult protection procedures, although they knew where the procedures were and would consult them when required. Bolton Hall Care Home J55 S6473 Bolton Hall V247498 140905 UI Stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21 and 24 The home was in the main well maintained. Bathrooms were clean, well decorated and not used to store inappropriate items. Residents were happy and comfortable in their rooms. EVIDENCE: In the main the environment was well maintained. The corridors had been decorated and the ground floor corridor carpet had been replaced. Some bathroom flooring had been replaced and the shower room had been refurbished, improving the environment for residents. However there had been some damage to a wall on the ground floor corridor, the deputy manager stated that this had been caused by a leak from the shower and was in the process of being redecorated. Appropriate bins for the disposal of incontinence products were provided. In the main residents were happy with their rooms stating that they were comfortable and had everything that they need.
Bolton Hall Care Home J55 S6473 Bolton Hall V247498 140905 UI Stage 4.doc Version 1.40 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29 Sufficient staff with an appropriate mix of skills was on duty to meet the needs of residents. The home is in the process of working towards fifty percent of care staff being NVQ level 2 trained. Residents were protected by recruitment policies and procedures. EVIDENCE: On the morning of the inspection, the manager and the deputy manager were on duty. There were also two nurses and ten care staff, six cleaners, three kitchen staff, two laundry staff, a handyman, a gardener and the administrator. Some residents stated that there was enough staff on duty to look after them, while other though that there should be more staff during the day so that they could spend more time with residents. In the main staff felt that there was enough of them on duty to meet deliver a good standard of care, but felt that the service would be improved if they could spend more time with residents or have the opportunity to take residents out more. The manager stated that approximately 40 of care staff were NVQ level 3 trained and when the staff currently undertaking the training had completed it the target of 50 would be reached. Three staff files contained the appropriate recruitment information including, two written references and a CRB disclosure, which were received before staff commenced employment. A nurse’s file contained evidence that they were registered with the Nursing and Midwifery Council, protecting residents.
Bolton Hall Care Home J55 S6473 Bolton Hall V247498 140905 UI Stage 4.doc Version 1.40 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 and 38 There is a quality assurance process in place; this could be improved by involving residents more in discussions about the running of the home. Systems in place safeguard the financial interests of residents. The health safety and welfare of residents and staff were protected. Bolton Hall Care Home J55 S6473 Bolton Hall V247498 140905 UI Stage 4.doc Version 1.40 Page 16 EVIDENCE: A representative of the company visits the home regularly and completes a report, which is forwarded to the Commission for Social Care Inspection. Some residents and staff spoken to stated that they were not asked their views on the running of home. Residents spoken to were happy with the current arrangement for the management of their finances. Records checked relating to valuables and money held on behalf of residents were completed appropriately and included two signatures for every transaction. The home had reviewed its practices following a break in June and evidence was available that the company had reimbursed resident’s losses. The servicing of electrical systems, portable appliances, the lift, hoists and gas appliances had been carried out. The hot water temperature tested was around 43 degrees centigrade and records were available to show that water temperatures were monitored regularly. The safety of residents and staff was promoted as, clear access to fire fighting equipment was maintained, the staff room was locked when not in use and hazardous substances were appropriately stored. Regular fire drills were carried out and staff stated that they had received fire training and moving and handling training. The fire officer had visited and the recommendations made following his visit had been met, maintaining the health safety and welfare of staff and residents. Bolton Hall Care Home J55 S6473 Bolton Hall V247498 140905 UI Stage 4.doc Version 1.40 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 x 3 x x 3 x x STAFFING Standard No Score 27 3 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 2 x 3 x x 3 Bolton Hall Care Home J55 S6473 Bolton Hall V247498 140905 UI Stage 4.doc Version 1.40 Page 18 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 8 33 Regulation 15 24 Requirement All residents care plans must include risk assessments relating to nutrition. Residents views of the home must be sought as part of the quality monitoring process. Timescale for action 14.12.05 14.01.06 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. Refer to Standard 18 28 Good Practice Recommendations Senior staff should receive further infromation regarding the implementation of the local authority adult proteection procedures. The home should continue with its training programme to ensure that 50 of staff are qualified to NVQ level 2 or equivalent by 2005. Bolton Hall Care Home J55 S6473 Bolton Hall V247498 140905 UI Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection Ground Floor, Unit 3 Waterside Court Bold Street Sheffield, S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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