Inspection on 20/08/09 for Boroughbridge Manor & Lodge

This inspection was carried out on 20th August 2009.

CQC found this care home to be providing an Poor service.

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

Boroughbridge Manor & Lodge 02/02/10

Boroughbridge Manor & Lodge 16/12/08

Boroughbridge Manor & Lodge 21/08/08

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Boroughbridge Manor & Lodge Roecliffe Lane Boroughbridge York YO51 9LW Lead Inspector Carol Haj-Najafi Key Unannounced Inspection 20th August 2009 09:30 DS0000070786.V377220.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 2 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 Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Boroughbridge Manor & Lodge Address Roecliffe Lane Boroughbridge York YO51 9LW 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) 0845 603 8218 01423 326 377 boroughbridgelodge@orchardcarehomes.com www.orchardcarehomes.com Orchard Care Homes.Com Limited Manager post vacant Care Home 76 Category(ies) of Dementia (42), Old age, not falling within any registration, with number other category (34) of places Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC; 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 - Code OP; Dementia - Code DE. The maximum number of service users who can be accommodated is: 76 16th December 2008 2. Date of last inspection Brief Description of the Service: Boroughbridge Lodge And Manor care home can accommodate up to 76 older people, who require help with personal care including some people with mental health needs. The home is a new building situated in its own private grounds, only a short distance from the market town of Boroughbridge. All of the bedrooms are well equipped and have en-suite facilities. People can access all floors by stairs or a passenger lift. At the inspection in August 2009, the acting manager told us the fees range from £610.00 to £666.00. Information about the home, including the last inspection report and up to date fees is available at the home. The homes Statement of Purpose and Service User Guide is available on request. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is Zero star – poor service. This means the people who use this service experience poor quality outcomes. The Care Quality Commission (CQC) inspects care homes to make sure the home is operating for the benefit and well being of the people who live there. More information about the inspection process can be found on our website www.cqc.org.uk. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The last key inspection was carried out in December 2008. We carried out this key unannounced inspection earlier than planned because we received information that raised serious concerns about the home. We did not send out a questionnaire for the home to complete or send out surveys before our inspection because we inspected quickly in response to the concerns. Two inspectors were at the home for one day from 9:30am to 8:10pm. We spoke to six people who live at the home, seven staff, the temporary acting manager and the area manager. We looked around the home, and looked at care plans, risk assessments, daily records and staff records. We observed how staff interacted with people who live at the home. We spent a total of 10 hours and 40 minutes at the home. Feedback was given to the acting manager and area manager at the end of the visit. At the end of the visit we issued an immediate requirement because we had concerns about the safety of the people who live and work at the home. After the inspection we wrote to Orchard Care and told them they must take action to make sure people are safe. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 6 What the service does well: Staff told us the home is good at making sure people are comfortable when they start living at the home. One staff member described a recent admission which included spending time with the person and their family finding out about the person’s history, likes, dislikes and routines. Some people who live at the home told us they have flexible routines and decide when to go to bed and when to get up. One person said, “I can get up at 6 o ‘clock and that is my choice.” Another person said, “I am very content. I can do most things myself but can get help if necessary.” The home is spacious, nicely decorated and furnished, and generally clean and tidy. People have personalised their rooms. One person who lives at the home said, “It’s spotlessly clean. They vac and dust every day and I have clean linen every week.” People who live at the home told us the staff who work regularly at the home are nice. One person said, “The regular staff are very, very kind.” Another person said, “The staff are lovely, absolutely lovely.” We spoke to five visitors. They told us they can visit anytime and are made to feel welcome. One person who lives at the home said they are very happy that their relative is always offered a cup of tea when they visit. What has improved since the last inspection? When we carried out our inspection we identified a number of areas where the home was failing to provide a good quality and safe service. A temporary acting manager had been working at the home for three days. From our observations it was clear that the acting manager had identified several problems at the home, and had started to take action to put some things right. The acting manager is very experienced and has a good understanding of what systems should be introduced to improve the standard of care. Staff told us the acting manager has so far been very supportive and they think she will be good for the home. One person said, “She wants things done and she knows what she is doing.” When we talked to people who live at the home they were aware that a new acting manager was at the home, several knew her name and had already spoken to her. The area manager had also identified problems which is why an experienced manager has been brought in. People who live at the home also knew the area manager and said he visits and asks if people are ok. The area manager knew people by name and from our observations it was evident that they were familiar with him. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 7 What they could do better: People who live at the home could have a better care plan that identifies their individual care needs and how these should be met. This will make sure people’s needs are met. Information about people who live at the home could be passed on to relevant professionals when they are involved in a person’s care. This will make sure people’s needs can be properly assessed and identified. When medication is administered to people who use the service it could be more clearly recorded. Staff could be better at following the homes medication policy and procedure when ordering, receiving and disposing of medication. This will make sure people receive the correct levels of medication. People could be treated with privacy and dignity at all times. This will help make sure peoples rights, privacy and dignity are maintained. One person said there was an occasion when the staff did not know how to use the hoist so they had to go without any pants on. Another person said staff are very busy on a morning and when they are being assisted to get up staff often have to break off to help others and answer the call bell. People who live at the home could be offered more daily activities. This will give people a more stimulating and fulfilling lifestyle. People who need assistance to eat and drink could be given better support during meal times. This will help make sure people’s needs are met. Complaints could be properly investigated and recorded. This will make sure complaints about the service are dealt with appropriately and action is taken to make sure problems are resolved. The registered person could make sure the home has a robust safeguarding process for dealing with abuse. This will make sure people who use the service are safeguarded. Equipment could be stored more appropriately. This will make people are safe and rooms can be used for their original purpose. The environment in the dementia care unit could be adapted so it is more appropriate to meet the needs of people with dementia. Staff who are supporting people who live at the home could know more about how their needs should be met. This will make sure people receive consistent care that meets their needs. The home could have a higher percentage of staff with NVQ level 2 or above. This will help make sure people’s needs are met. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 8 Staff could receive more training that equips them with the knowledge and skills to deliver a safe service that meets the specialist needs of the people who live at the home. This will make sure people are safe and individual needs are met. The home could have a registered manager that is qualified, competent and experienced. This will make sure people benefit from a well run home. The quality of the service could be better monitored through the home’s quality assurance system. This will help improve the quality of the service and make sure the home’s aims and objectives are being met. Accidents could be recorded in more detail and monitored more closely. People who are injured or suspected of having an injury could receive more appropriate healthcare support. This will make sure people who live at the home are safe and have all their needs met. The Care Quality Commission (CQC) could be notified more when there are significant events that affect the health and welfare of people who live at the home. This will make sure CQC receives appropriate information and can monitor the health and welfare of people who are living at the home. Practice fire drills could be carried out more often so people know what to do in the event of a fire. This will make sure people are safe. 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 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. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 9 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 Outcomes Statutory Requirements Identified During the Inspection Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are properly assessed before they move into the home, which makes sure their needs are known. EVIDENCE: Staff told us the home is good at making sure people are comfortable when they start living at the home. They said a keyworker is allocated, and where possible the keyworker spends time with the person when they arrive. One staff member described a recent admission when they had been responsible for introducing the person to the home. The staff member said she spent time with the family and got as much information about the person’s history, likes, dislikes and routines as possible. When the person who was moving in arrived from hospital the staff member said they spent time making Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 11 them comfortable, showing them around and introducing them to other people at the home. They then talked to the person about the home and found out what they liked and what they wanted. We looked at one person’s pre assessment records. They had an assessment that was completed before they moved into the home. The assessment and a discharge letter from the hospital contained information about the type of support they required. When we looked around the home we noticed people had service user guides and terms and conditions in their rooms. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not receive consistent care which has sometimes resulted in their needs not being properly met and their dignity not being respected. People who live at the home are being put at risk because medication procedures are not being followed which could result in people not receiving the correct medication. EVIDENCE: People who live at the home told us somethings are done well but somethings should improve. One person said, “I’m very happy and am well looked after. It’s a problem when agency staff are here.” Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 13 Staff talked about promoting privacy and dignity and gave us examples of how they do this. Staff were seen to knock on people’s doors. People who live at the home told us staff generally respect their privacy and dignity although two people did raise concerns. One person said there was an occasion when the staff did not know how to use the hoist so they had to go without any pants on. Another person said staff are very busy on a morning and when they are being assisted to get up staff often have to break off to help others and answer the call bell. Part of the day was spent talking to people and observing the care being given to people. This included how staff interact with people at the home. We saw staff treating people with respect and being kind and courteous. We also saw that at times during the lunch meal staff were not interacting well with people which we have covered in more detail in the lifestyle section. In a number of bathrooms we noticed some unlabelled toiletries including large bottles of cheap bath foam, large talc, bars of soap and sponges. This suggests that they are for communal use, which is not appropriate and does not promote dignity or individuality. We received a mixed response about the laundry service. One person who lives at the home told us ‘everything is beautifully washed and ironed’. Others said it was not a good service. The acting manager said she had received a complaint about the laundry the day before our inspection. We looked at two peoples care plans. These were well organised. Some information in the care plans was good and gave sufficient information about potential risks and how individual needs should be met. Other information was vague and didnt really explain how the persons needs should be met. One person’s care plan described them as aggressive but it did not say what is ‘aggressive’. This makes it hard for people to provide consistent care and meet people’s needs if their needs are not properly identified. One person’s assessment identified that they should have their food cut up and they like sugar in their tea, but the person’s care plan did not contain this information. Staff told us that one person had recently seen an occupational therapist, and they have hourly checks during the night. This information was not in their care plan. A range of risk assessments have been completed and these identify the level of risk. In the main, the assessments were satisfactory although one assessment had not been properly completed. The person’s name had not been filled in and sections that were not relevant had not been deleted. This made it difficult to establish the level of risk. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 14 We talked to staff about care planning. They said the plans are regularly used but because of staffing difficulties they struggle to find time to complete the care plan reviews. We attended a safeguarding meeting about an incident that had taken place at the home. Two professionals who visit the home on a regular basis raised concerns that important information should have been shared with them but the home had failed to do this. A GP visits the home once a week and holds a ‘surgery’. People told us their healthcare needs are met. They said they regularly see the GP and an optician and chiropodist visit the home. We looked at records that showed us people have attended regular healthcare appointments. During our visit the acting manager talked to us about the way medication is managed at the home. She has identified some problems and has already met with staff and is taking action to improve things. We looked at how medication is stored, checked some of the home’s records and observed staff giving people their medication. Appropriate storage facilities are provided, including air conditioned clinic rooms and medication fridges. However, the manager had found a large amount of medication that should have already been returned to the pharmacist and staff had not been monitoring the fridge and room temperatures regularly. The staff we observed gave out medication in a safe way. For example, washing her hands, locking the medication trolley when she left it unattended and making sure people had a drink and had taken their medication before signing the medication administration record (MAR). However, when we looked at records we found that people couldn’t always take their medication when they needed it, because it was out of stock and staff hadn’t ordered new stock in time. This is bad practice and shouldn’t be happening. We also found that staff were not recording everything that they should on the MAR. For example, they were not recording when medication entered the home or when it was returned to the pharmacist. They were not recording stock balances that were carried over from one month to the next and they were not recording how much medication someone had taken when a variable dose was prescribed. Where staff had handwritten the details of a medication on the MAR the entry was often not dated or signed, and had not been checked for accuracy and countersigned by another person. This poor standard of record keeping meant that it was impossible for the manager to really check if medication was being administered properly and an audit trail was not available. We checked how controlled drugs were stored and administered. We checked the recording in the controlled drugs register and medication stock balances for two people. Staff were not always recording all of the information that they Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 15 should be in the controlled drugs register. For example, one entry for new stock didn’t say the amount received and hadn’t been signed by the person completing it. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the 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 can organise their time enjoy a flexible routine. Others who need more support would benefit from more stimulation on a day to day basis. This would help make sure people have a more varied lifestyle regardless of their abilities. EVIDENCE: Some people who live at the home told us they have flexible routines and decide when to go to bed and when to get up. One person said, “I can get up at 6 o ‘clock and that is my choice.” Another person said, “I am very content. I can do most things myself but can get help if necessary.” We spoke to five visitors. They told us they can visit anytime and are made to feel welcome. A relative said they receive important information from the home. One person who lives at the home said they are very happy that their relative is always offered a cup of tea when they visit. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 17 People who live at the home and staff generally thought the level of activities should improve. Some people who live at the home said they used to do more activities but ‘nothing much’ recently. Two people said they like to organise their own time and one person said ‘I’m very lazy’. Others said they would like more activities. Some people said they get chance to go out but would like to go out more often. Staff said generally they do not have sufficient time to spend quality time with people. Some staff said they have time on an afternoon to do activities but not on a morning. An activity programme was displayed in the home but staff said this is generally not followed. We observed the lunch time meal being served on the middle floor of the dementia care unit. The dining room tables had been set with cloths, napkins and cutlery and the food was brought from the kitchen in a hot trolley. Lunch was either liver and onions, served with vegetables and potatoes or quiche, served with chips and beans. One lady was served a cheese salad, as an alternative to the two main choices. Dessert was chocolate pudding with chocolate sauce. We tried the food being provided and found that it was tasty and pleasant to eat. However, people who need a soft diet were served a bowl of pureed liver, potato and vegetables that had all been mixed up together. This resembled brown mush and did not look appealing. We noticed that staff didnt ask people what they wanted to eat or show them the different options so that people could decide for themselves. When we asked staff about this they told us that people are asked what they want either the day or morning before and that staff decide for the people who cant make up their own minds. We observed staff helping people to eat. For example, one member of agency staff sat next to someone and fed them. However, there was little interaction between them. For example, very little talking and reassuring to help make it a more pleasant and dignified experience for the person being fed. Some people needed help to cut up their food, but staff didnt offer this for some time after the meal was served. We saw that one person didnt eat all of their food because staff hadnt cut it up and they couldnt manage unassisted, despite it saying in the persons care plan that staff need to cut up their food for them. During the morning we saw people being offered hot drinks and biscuits. We also saw that later in the morning staff cut up fresh melon and oranges, giving each person a portion of fresh fruit to eat on a plate. One person helped themselves to crisps from the snack basket that was located in the dining room. Staff told us that there are plenty of snacks and drinks available during the day if people are hungry. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 17 & 18 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Safeguarding practices are not robust and do not safeguard people who live at the home. Complaints have not been dealt with appropriately so people are not confident they will be listened to. EVIDENCE: We talked to people who live at the home about raising concerns and making complaints. Everyone said they had people they could talk to if they are unhappy. Some people said they would talk to their family, others said they would talk to staff or management. One person said they had spoken to the area manager about a concern and he had ‘sorted things out’. We also spoke to staff about passing on any concerns. Everyone said they would be happy to talk to the new acting manager and area manager and are confident they would deal with things appropriately. Some staff did say that when they had raised concerns in the past these had not been dealt with satisfactorily. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 19 We asked to look at the home’s complaint’s record. The acting manager found the complaint’s file but it did not contain details of complaints the home has received. The area manager said he had copies of complaints sent to the organisation and would put these into the file. We carried out the key inspection early because we were concerned that the home was not following safeguarding procedures which could result in people not being protected from abuse. We received a notification from the home that told us there had been a serious incident at the home. When we checked with the home we found out they had not reported the incident to the local authority or the police, which they should do under their safeguarding procedure. At a safeguarding meeting, a representative from Orchard Care acknowledged the home had not dealt with the incident appropriately and it had not followed procedures. The representative said the incident was not reported appropriately and records of the incident were not completed satisfactorily. At this inspection we looked at some of the home’s accident forms and found that at least five other safeguarding incidents had occurred at the home and they had failed to follow their safeguarding procedures. For example, an accident form stated that one person was ‘kicked in the stomach and pushed over’ but it was not evident whether the person got any medical attention. Another form stated that a person was heard ‘screaming and found on the floor’ with another person who lives at the home ‘standing above them’. These incidents were not reported to CQC or any other agency. The acting manager, who has just started working at the home, knew that any safeguarding incidents should be reported to the local authority and where appropriate to the Police. She knew how to make safeguarding referrals and had made a referral the previous day. We are confident that the acting manager would follow the safeguarding procedure. Staff we spoke to were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They said they report any concerns to the management team, including any incidents between people who live at the home. We spoke to seven staff but only the deputy manager knew that management should report safeguarding incidents to the Local Authority. The majority of staff said they have attended safeguarding training. The training records showed us that twenty-two out of thirty-eight staff had received training. Thirteen staff had not received safeguarding training for over twelve months even though the organisation states that staff should receive safeguarding training annually. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the 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 live in a pleasant and comfortable environment although the dementia care unit could cater more for the specialist needs of people with dementia. Some equipment is not being stored appropriately which could put people at risk. EVIDENCE: People who live at the home said the home is clean and tidy. One person said, “It’s spotlessly clean. They vac and dust every day and I have clean linen every week.” We looked around the home which is nicely decorated and furnished, and generally clean and tidy. People told us they enjoy sitting outside when the Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 21 weather is nice. People have personalised their rooms with pictures, photographs and other personal items. Staff said they wear protective clothing when attending to the personal care needs of people who live at the home. Hand wash facilities are available throughout the building, which helps make sure infection control is properly managed. However, there were no bins in bathrooms to put hand towels in. The manager showed us an order that confirmed fifteen new waste bins had been purchased. One downstairs bathroom was being used to store equipment and contained two hoists, a shower chair, a cleaning trolley and a vacuum cleaner and a shower room next door contained some sit on weighing scales. In two rooms we noticed that district nurses supplies were visible. One of these rooms was on the dementia care unit where someone could wander into room and access the supplies. The dementia care unit was decorated and furnished the same as the other unit of the home. There were no special facilities to help people find their way around the home. For example, bathrooms and toilets were not signed adequately and there was nothing to make the environment more stimulating for people. Peoples bedrooms have a current photo but people with dementia will often not recognising themselves as they are today. Some beds were not well made. Some duvet covers did not fit the duvets and sheets were not tucked in. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 22 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 consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are not supported by permanent, suitably trained or competent staff which has led to people’s needs sometimes not being properly met. EVIDENCE: People who live at the home told us the staff who work regularly at the home are nice. One person said, “The regular staff are very, very kind.” Another person said, “The staff are lovely, absolutely lovely.” Some people raised concerns about the competency of staff but said this mainly relates to the agency staff. One person said, “We get a lot of agency staff and some don’t know what they are doing.” Another person said, “On a night I get agency staff to help me but they don’t know what to do.” People said they often get different agency staff working at the home and thought it would be better if the same agency staff worked so they could get to know people and the routines of the home. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 23 One person said a staff had recently spoken to them sharply but did not wish to discuss this any further. They said they would speak to the area manager about their concern. Some people who live at the home raised concerns about the staffing levels and gave examples when they have not received a good standard of care. Staff also said there are not always enough staff to meet people’s needs. When we looked around we noticed that no staff were available on the top floor of one unit for at least 10 minutes. One person needed help to get up on her bed and needed her legs lifting, but no one was around to help. We also noted that on one floor of the dementia unit a bath was running with the door left open. No staff were in the vicinity of the bathroom. Staff also raised concerns about the amount of agency use and staffing levels. Some staff said they struggled to carry out their tasks because there is not enough staff. We were told that staffing levels are inadequate when senior staff are administering medication or carrying out other duties. Concerns were also raised that night staff are not doing their regular checks during the night or supporting people with personal care. One staff said, “We leave clean towels in bedrooms. People have supposedly been washed and supported to get up but the towels haven’t been used.” We attended a safeguarding meeting about an incident that had taken place at the home. Concerns were raised because night staff had not checked that one person was safe even though staff believed the person had been involved in an incident. During our inspection we noted that staff who work at the home on a regular basis were spending a lot of time directing staff who were not familiar with the home. This obviously has an impact on staff time. We asked to look at staff rotas for the last four weeks. The acting manager could only find three week’s rotas. The rotas did not accurately show how many staff had been working on each shift because agency staff were not included. Over a four week period the home used 990 agency hours. The records told us the home has used an excessive number of agency staff especially on a night. The home has five night staff. On several nights three and four agency staff were regularly used, and on at least one night the home was staffed only by agency staff. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 24 The area manager said they have reviewed staff rotas because they were not working effectively and the new rotas are being introduced on 27 August. He said the use of agency staff is not spread out evenly and the rota patterns do not provide consistency and continuity. He said the new rotas will address these problems. We asked to look at staff training records. The home could not provide us with evidence to show that staff had attended appropriate training to equip them with the skills and knowledge to meet people’s needs and keep people safe. The organisation has a training programme that identifies what training staff should complete but the staff at the home have not received the recommended training courses. Some staff had not completed fire safety training; others had not completed refresher fire safety training. According to the records only five staff had up to date fire safety training and sixteen staff have NVQ level 2 or above. The home employs fifty eight staff. At a safeguarding strategy meeting everyone was informed that the home has an ‘appointed first aider’ on duty at all times. The records showed us that only three people at the home have completed ‘First Aid at Work’ which is the course they attend to become an appointed first aider. The acting manager said she did not know if the training records were an accurate reflection of training that staff have attended because she was unsure whether the records had been updated. The training manager faxed through attendance training forms to show that staff have attended some training in the last twelve months. These told us twenty four staff attended safeguarding training, ten staff attended dementia awareness, eleven staff attended moving and handling, thirteen staff attended first aid awareness and nine staff attended food hygiene awareness. Staff told us they have not attended regular training. Some said they have not attended fire training. One staff said they have not done moving and handling training but carry out moving and handling tasks. Another staff said they had asked to attend dementia training but this never took place. Another staff said they attended training when they started over eighteen months ago but had not attended any training since. No training or induction records were available for two people who have recently started working at the home. One person started in May and the other person started in June. The acting manager checked the computer system and contacted the training department but there was no record for the two staff. We asked staff about induction training. Staff said they had three days induction but generally this was not structured. One person said they had done three days induction in one unit. The unit has three floors but they only spent Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 25 time on one floor. When they had to work alone they were confident on one floor but not confident on the other two floors. The staff member said they had worked at the home for several months but were still waiting to attend fire training, moving and handling training, first aid training and food hygiene training. As stated in the Health and Personal care section of this report concerns were raised about staffing which has compromised the dignity of people who live at the home. Staff told us the team has gone though a difficult period but generally felt that team work and staff morale has improved recently. They said communication has also improved and handovers were better. The area manager said they have had problems recruiting and retaining staff, especially senior night staff. They are hoping to fill three of the senior positions which should resolve some of the staffing problems. We looked at the recruitment process for two people who have recently started working at the home and found that pre employment checks were completed satisfactorily. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 26 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 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of a consistent management team and effective management systems has led to the home failing to provide a safe and consistent service to people who live at the home. EVIDENCE: When we carried out our inspection the home was being managed by a temporary acting manager who had only worked at the home for three days. The acting manager is a registered manager from another Orchard Care home and has been seconded to manage Boroughbridge Manor and Lodge for at least one month. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 27 From our observations it was clear that the acting manager had identified several problems at the home, and has started to take action to put some things right. The acting manager is very experienced and has a good understanding of what systems should be introduced to address the problems. Staff told us the acting manager has so far been very supportive and they think she will be good for the home. One person said, “She wants things done and she knows what she is doing.” When we talked to people who live at the home they were aware that a new acting manager was at the home, several knew her name and had already spoken to her. The area manager had also identified problems which is why an experienced manager has been brought in. People who live at the home also knew the area manager and said he visits and asks if people are ok. The area manager knew people by name and from our observations it was evident that they were familiar with him. One person said they had spoken to him about a concern which was sorted out and asked if they could talk to him again. The area manager dealt with this promptly. The home has not had a registered manager since the end of February 2008. Several acting managers have managed the home since then. Orchard Care has quality assurance manuals in place and audits have been completed by the previous manager. However, in light of the findings at our inspection it is evident that the systems have not been effective. We looked at financial systems for people who live at the home and found that these are generally satisfactory. Monies are stored securely in a safe. We talked to the home’s administrator who told us people can choose to keep their own money, or ask the home to manage their money or have direct billing for extras that have been purchased. Computerised records are in place and receipts are obtained for any purchases made on behalf of people. We checked monies for one person and their balance sheet and monies were correct. The administrator was not aware of any recent financial audits. We looked at accident records for one of the units and were concerned about the number and nature of some accidents that were recorded. The records showed us that there appeared to be a lot of accidents. In May thirty two accident forms were completed for people living in one unit. Several people had fallen out of bed but it was not clear what action had been taken in response to this to prevent it happening again. One person had fallen out of bed seven times in the last four months. We did not see evidence that preventative equipment has been put in place (e.g. bed wedges or similar alternatives to bedrails). Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 28 We were told the home has a ‘no bed rail policy’, and the district nurse would be asked to complete an assessment if they were concerned that someone was at risk from falling out of bed. A member of the management team said they had not reached that stage yet. It was not clear from some of the accident records what attention people had received if they had sustained injuries. One person had a cut to their head but the record did not say if they had gone to hospital. Another person had cut their mouth and again it was not clear what support they were given. One person told us they had an accident and had been taken to hospital. We looked at the accident record, and this did not reflect what the person described and did not state whether they went to hospital. An accident form stated that one person had fallen and badly bruised her face/head resulting in hospital treatment. We checked the person’s personal record and the home’s notification file and found that this had not been reported to Care Quality Commission (CQC). We did not see evidence that accidents and safeguarding incidents are being properly managed or followed through during care reviews. A number of people have had accidents and it is unclear whether they have received appropriate medical attention or appropriate action has been taken to prevent further accidents. The home must tell CQC about important events and incidents involving the people who use their service which includes any serious injury that results in a consultation with a medical practitioner. The home has failed to do this on many occasions. The acting manager and area manager said they have identified that the home has not been reporting important events to the relevant agencies. Care staff, seniors and deputies knew to record incidents and accidents and everyone we spoke to felt confident that they are recorded. Several staff said they had not completed some mandatory training or needed refresher training. Three out of seven staff said they had not completed fire training, one staff said they had not done moving and handling training but were carrying out moving and handling tasks. We looked at staff training records which showed us that staff training is not up to date. Training records for fire safety showed us that most people had not done any training. Those that had completed the training had not completed refresher training within the recommended timescale. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 29 The area manager said they would up date all mandatory training for all staff. He said they would bring in a moving and handling trainer the day after our inspection. At the inspection we left an immediate requirement form. We were concerned because staff had not received appropriate fire and manual handling training. Regular fire drills had also not been taking place. In the immediate requirement we said that all staff must be briefed on fire safety and what action they take in the event of a fire at the start of their next shift, and management must make sure that staff who undertake manual handling tasks are competent to do so safely. We looked at some health and safety records. Fire alarms tests and checks of extinguishers have been recorded weekly, and emergency lighting monthly. Fire alarms were serviced in April 2009. The last recorded fire drill was in April 2008. A Health and Safety visit was carried out by the local council a week before our inspection. They identified that some work must be completed to meet Health and Safety at Work legislation. The work relates to risk assessment, lifting equipment and legionella. The acting manager said everything in the Health and Safety report is being addressed. In October 2008, an Environmental Health visit was carried out and some work should have been carried out to meet Environmental Health standards. Not all the work has been completed. They had identified that hot trolleys were dirty. These were also dirty when we visited, and the acting manager requested staff to clean them. The Fire Authority visited in June 2009 and were satisfied but identified some minor areas of non compliance. Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 30 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X X 1 Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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 Standard OP9 Regulation 13 Requirement When medication is administered to people who use the service it must be clearly recorded. Medication must always be available in sufficient quantities so that people are able to take their medication as prescribed. Staff must follow the homes medication policy and procedure when ordering, receiving and disposing of medication. This will make sure people receive the correct levels of medication. 2 OP10 12 People must be treated with privacy and dignity at all times. This will help make sure peoples rights, privacy and dignity are maintained. Complaints should be properly investigated and recorded. This will make sure complaints about the service are dealt with appropriately and action is taken to make sure problems are DS0000070786.V377220.R01.S.doc Timescale for action 30/09/09 30/09/09 3 OP16 22 31/10/09 Boroughbridge Manor & Lodge Version 5.2 Page 32 4 OP18 13 5 OP27 18 6 OP30 18 7 OP38 13 8 OP38 37 9 OP38 13 resolved. The home must make sure the home has a robust safeguarding process. This will make sure people who use the service are safeguarded. Staff who are supporting people who live at the home must know how to meet their needs. This will make sure people receive consistent care and people’s needs are met. Staff must receive training that equips them with the knowledge and skills to deliver a safe service that meets the specialist needs of the people who live at the home. This will make sure people are safe and individual needs are met. Any accident must be recorded in sufficient detail, monitored and appropriate healthcare support provided. This will make sure people who live at the home are safe and have all their needs met. The Care Quality Commission (CQC) must be notified of significant events that affect the health and welfare of people who live at the home. This will make sure the regulatory authority receives appropriate information and can monitor the health and welfare of people who are living at the home. Practice fire drills must be carried out in accordance with the home’s fire safety policy and procedure so people know what to do in the event of a fire. This will make sure people are safe. 30/09/09 30/09/09 30/09/09 30/09/09 30/09/09 30/09/09 Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 33 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. Refer to Standard OP7 Good Practice Recommendations The care planning and risk assessment process should be developed to make sure people’s care needs are properly identified. This will make sure people’s needs are recognised and met. Relevant information about people who live at the home should be passed on to relevant professionals when they are involved in a person’s care. This will make sure people’s needs can be properly assessed and identified. People who live at the home should be offered more daily activities. This will give people a more stimulating and fulfilling lifestyle. People who need assistance to eat and drink should be given better support during meal times. This will help make sure people’s needs are met. Equipment should be stored appropriately. This will make people are safe and rooms can be used for their original purpose. The environment in the dementia care unit should be adapted so it is more appropriate to meet the needs of people with dementia. The home should have a higher percentage of staff with NVQ level 2 or above. This will help make sure people’s needs are met. The home should have a registered manager that is qualified, competent and experienced. This will make sure people benefit from a well run home. The quality of the service could be better monitored through the home’s quality assurance system. This will help improve the quality of the service and make sure the home’s aims and objectives are being met. 2. OP8 3 4 5 6 7 8 OP12 OP15 OP19 OP19 OP28 OP31 9 OP33 Boroughbridge Manor & Lodge DS0000070786.V377220.R01.S.doc Version 5.2 Page 34 Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@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. 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