Inspection on 03/07/07 for Borrage House

This inspection was carried out on 3rd July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Borrage House 06/07/06

Borrage House 07/02/06

Borrage House 01/12/04

Borrage House 20/05/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Borrage House 8 Borrage Lane Ripon North Yorkshire HG4 2PZ Lead Inspector Denise Rouse Unannounced Inspection 3rd July 2007 10:30 X10015.doc Version 1.40 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 Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 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 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. Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Borrage House Address 8 Borrage Lane Ripon North Yorkshire HG4 2PZ 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) 01765 690919 01765 600021 jean.rowlinson@anchor.org.uk jane.ashcroft@anchor.org.uk Anchor Trust Jean Rowlinson Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 06/07/06 Brief Description of the Service: Borrage House is registered to provide personal care for 40 people aged 65 years and above. It is owned and operated by Anchor Trust. The Original building is a private dwelling house, which has three floors and a two-floor extension has been added at the rear of the site. The residents are located on the ground and first floors only and there is an eight-person passenger lift to provide level access to the first floor. It is located near the centre of the city of Ripon and there is large garden and parking space to the side and rear of the main property. The weekly fees on 03 July 2007 range from £329.50 to £485.00 This information was supplied to the Commission For Social Care Inspection by the home manager upon the site visit. Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The accumulated evidence used in this report has included: • A review of the information held on the home’s file. • Information submitted by the registered provider in the Annual Quality Assurance Assessment record. • Surveys received from three service users and one relative. • An unannounced visit to the home by an inspector, which lasted five hours, which included a full tour of the premises. Evidence gained by direct observation, talking with service users, staff and a visitor. Inspection of records, including care profiles, medication administration records, staff files, personal allowance accounts and some of the homes policies and procedures. What the service does well: People are given enough information about the home to be able to make an informed decision about if their needs can be met. Comprehensive assessments are undertaken to from a clear easy to understand care plan, and all necessary health care referrals are made to ensure each person receives the care and monitoring that is appropriate to them. People have a good range of social activities available to them, which meet their preferred needs. Food served looked appetizing and well presented and met the assessed nutritional needs of the people within the home. Staff treat people with dignity and respect and work well as a team together, to ensure that people who live in the home feel safe and protected. Staff receive comprehensive training to improve their knowledge and skills. This means that residents receive care from a well-informed staff team whose practice is up to date. There is a clear complaints procedure; the manager shows a positive approach to complaints and ideas received. There are clear ways in which quality can be measured which included feedback from people who live in the home and their representatives. The home is well presented spacious and airy, people are involved in choosing some furnishings and can personalise their own bedrooms, ensuring a homely environment is created. Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 Page 6 The home is managed in a manner that places the people who use the service at its core, and concentrates on their needs, wishes and views. 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. The summary of this inspection report can be made available in other formats on request. Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 (Standard 6 not applicable) People who use the service experience good outcomes in this area. People have their needs assessed before moving into the home, to ensure their needs can be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Four people who had been admitted into the home were case tracked. They confirmed that they could look round and were provided with information about the home. A trial period was offered to each new person and they could stay for a meal upon their visit, to experience the service. This helped people make a decision about if the home was right for them. A service user guide and statement of purpose, as well as the last inspection report were made available to ensure all parties were fully informed about the home. Pre-admission assessments were in place and held on people’s individual files, care need assessments from local authorities, and hospital discharge Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 Page 9 information was also gathered. This helped to ensure care staff were fully informed and peoples needs were being met. One person commented “ Having looked at other care homes and spent time on respite care in two others, I consider this the best for my needs”. Another stated, “ My Attorney viewed the home at short notice on recommendation of a friend, we were impressed. Staff completed a two hundred mile round trip the following day to carry out the pre admission assessment”. Once the home stated they could meet their needs, an arrangement was made for them to be admitted later that same day. Another stated “ Two or three people recommended this home, I was sent a brochure, my relative was shown round, and I came in as soon as a room was free, I couldn’t find anywhere better, having experienced two other care home, The home is just lovely, you would not find anywhere better”. Intermediate care was not undertaken at the home. Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7 8 9 10 People who use the service experience good outcomes in this area. People’s health care needs are fully met, and they are treated with dignity and respect. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Four care records were inspected. Care plans and risk assessments were detailed enough and risk assessments including reducing risks of falls. One person who required regular monitoring regarding their weight had a detailed care plan and staff were assessing their nutritional intake. This ensured their needs were being met. Daily records were not always recorded but a new system was being commenced whereby entries would be made once a week, or if the persons needs changed. Care plan reviews were recorded in the daily entry section of the documentation and the recording that this review occurred could be somewhat difficult to locate monthly, one entry had been omitted. This was discussed with the manager and the review of care plans was to be recorded on the care plan. Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 Page 11 Referrals and visits by General Practitioners, dieticians and chiropodists take place and were recorded. Special equipment was provided for people to ensure their health care needs could be fully met. The medication system was inspected. The home operates a monitored dosage system. Proper procedures were in place for the administration and storage of medication, however balances of medications received were not being recorded. This was due to the short time span between the delivery of the medications to the home and the commencement of the new months medications. This was discussed with the manager and staff, for good practice they should consider how this could be rectified. People spoken with about their experiences of the home were positive and all stated they were treated with dignity and respect. A relative confirmed staff phoned if there were any problems, and so they felt they were kept fully informed at all times. They stated, “ I am more than happy with the home”. Another comment received was “My relative has been at Borrage House for several years. During that time I have been confident that they have been well cared for. They have been especially reassuring the past few months when I have had some health problems myself and have not been able to visit as often as I might wish”. This ensured that all relevant parties felt involved and fully informed. Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 13 14 15 People who use the service experience good outcomes in this area. People received a wholesome nutritious diet and can participate in creative activities, which meet their assessed needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People have a care plan for their preferred social needs. An activities programme was on display in the home. The enthusiastic activities coordinator was seen undertaking Bingo in the morning and activities in the afternoon well attended by the residents. People in the home all stated they were happy with the activities available and could join in if they wished, or could choose how to spend their time. Comments received about activities included “The new activities co-ordinator is marvellous, and it has cheered us up enormously, it gives us something to look forward to”. A payphone was available within the home, also a visiting library. There was a bank of library books available with normal and large print this was due to be extended. Quiet lounges and others with televisions were available so that people could socialise or sit peacefully throughout the home if they wished. Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 Page 13 A visitor said you “are always made to feel welcome” and visiting is open”. One person stated “ I can have visitors whenever I like, I go out locally, there’s no problem, staying here gives my family peace of mind, they are always made welcome”. Another person stated “ I go out on one night to play bingo, there’s always a drink available when I get back”. Religious services were held for people who wished to attend. Themed meals were provided at times when the home was fully staffed in the catering department. This ensured cultural needs were being met. People stated they could get up and go to bed as they wish, and follow their own personal routines, supported where necessary by the staff. The kitchen was inspected, it was clean and tidy. Food prepared for lunch looked appetising and the Chef was aware of peoples special dietary needs. Residents choose at mealtime what they would like to eat. Weekly menus were displayed within the home and a daily menu in large print was available. The dining room was clean, spacious and nicely set with linen tablecloths. Mealtimes were very sociable and unhurried. The chef had only recently changed the menu; the residents committee had been involved and requested more spicy foods, curries, chilli, as well as pasta and liver. These requests had been incorporated into the menu. The Chef took pride in his job, and stated that he enjoyed going and asking the people how the food was and liaising specifically with people who did not come out of their rooms. One service user sent down a specific list to ensure that all there dietary requests were fully met and this was an arrangement appreciated by both parties. Homemade cakes were produced and pride was taken in the quality and presentation of food served. Supper was available nightly. Fresh fruit and juice were freely available at any time. This ensured that people’s nutritional needs were met. One person commented,” the food is varied and adequate”. Another stated “ The food is excellent, the fish is very nice today”. And “ If you want anything they give it to the best of their ability”. Environmental Health had recently visited, there was an issue being resolved relating to a noisy kitchen extractor fan. Also one kitchen assistant required to undertake a Food Hygiene course, this was discussed with the chef and manager and this was to be undertaken locally as soon as possible, to ensure health and safety and food hygiene was maintained. Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 18 People who use the service experience good outcomes in this area. People’s complaints are dealt with and they are protected by the policies and procedures of the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home had a comprehensive complaints procedure in place, which was Available to people, and displayed on the notice board. People knew how to make a complaint. They were confident that issues raised would be dealt with. However the policy stated the National Care Standards Commission could be contacted, not the Commission for Social Care Inspection and this should be changed, to reflect the correct contact details. One person stated, “ I have never had to complain, I know who to go to”. Comprehensive policies and procedures for safeguarding people were seen including the local multi-agency agreement. Staff received training about abuse and safeguarding vulnerable adults. Staff questioned about the action they should undertake if an allegation of abuse were to be raised, were clear about the correct action to be taken, this helps to ensure that people are safeguarded. New staff have the necessary pre employment checks undertaken to ensure that they are fit to work within the care setting. Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards19 26 People who use the service experience good outcomes in this area. People live in a well maintained and decorated home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home had a welcoming and friendly atmosphere. Accomodation was provided over two floors, which could be accessed by a passenger lift or staircase. There were no offensive odours. Bedrooms and communal areas were clean and tidy and furniture and fittings were well maintained. People who had difficulty with mobility or used a wheelchair had access to all parts of the building and garden. Residents took a vote looking at carpet samples for a new carpet. Some could choose what colour to have their rooms decorated before moving into the home. This ensured that their views and wishes were listened to, and acted upon. Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 Page 16 The grounds were well presented and access was available to ambulant and wheelchair users. Staff had had to evacuate residents in the recent flood, People stated that the staff were wonderful and the whole process was well managed and they had not felt frightened but felt well protected during this process. This was commendable. People who lived in the home had personalized their bedrooms, with their belongings including pieces of furniture. Assisted bathrooms and toilets were situated near to service users bedrooms and communal areas. One person stated, “I have a lovely room, and I feel at home, I have some things of my own, my bed, my chair and my cabinet”. The laundry was inspected, the outer laundry door was held open whilst being unmanned by a wedge, and this was a fire door. This was discussed with the manager who promptly removed it; the staff were informed this must not occur. Behind the washers and dryers there was a build up of dust, this should be cleared, to ensure that staff and residents health and safety is maintained. Hand washing facilities were available throughout the home, to help prevent any risk of infection. Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards27 28 29 30 People who use the service experience good outcomes in this area. People are looked after by adequate numbers of well-trained staff. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People spoken with stated that the numbers of staff available in the home met their needs. All they were happy and felt the staff were well trained and professional. The manger was available one evening a week for visitors who worked during the day, and would cover some shifts as required, this helped to ensure that the quality of the service was overseen outside office hours. It also ensured that she was seen as part of the team, as well as keeping her aware of the needs of the people who use the service. Staff confirmed that training was undertaken in all mandatory areas. A training Matrix was inspected. The manager was aware at all times who required training in what subject. This ensured staff were well informed and the quality of the service was maintained. The home had encouraged care staff to undertake the National Vocational Qualification in Care at Level 2 or 3, however the ratio of staff currently holding this qualification was just short of 50 ratio, the home was working Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 Page 18 hard to achieve this, and should continue to do so. One member of staff required food hygiene training this was to be sourced locally. Three staff files were inspected and found to be in order, with all references and pre employment checks undertaken. Ensuring that staff were suitable to work in the care industry. Comments received included “ Staff are very good, nothing is too much trouble”. Also “Staff are kind & patient” And “ Nothing is any bother, all staff are generous with their time”. Also “ Staff make time to chat to the people who live at the home”. A relative confirmed that staff have time to sit with people when they were unwell and this gave great comfort. Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31 33 35 38 People who use the service experience good outcomes in this area. People live in a home that is managed well by an experienced person. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home was managed well by a competent and approachable person, who was experienced in care and management. The manager had an open door policy in operation and the home had a friendly welcoming and professional atmosphere. Staff relatives and residents were seen approaching the manager with ease. Residents stated they could not find a better home; a visitor spoken with at the home shared this view. Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 Page 20 Four peoples personal allowance finance balances were checked, some receipts were missing from purchases from the internal shop, the manager was to commence receipting these items, to ensure a full receipted record of all transactions were kept. Each person had an individual record held on the computer of all monies received and paid out, the balanced were checked against the record. Individual cash balances were not held separately. This is believed to have been agreed with the Commission for Social Care Inspection. People’s financial interests were sufficiently safeguarded. Staff confirmed that staff supervision and annual appraisals were carried out, to ensure training issues and staff support was relevant. Quality Assurance systems were in place and the home was audited regularly by the organisation. One of the organisations area managers carried out regular monthly visits to the home and a report was available. Internal surveys were undertaken and the results were distributed to all residents. An independent company also had carried out a survey. Departments were being audited regularly and every six months an external company manager audited the kitchen. This ensured that any shortfalls in the service would be rectified quickly. A newsletter was produced, this was very professional and included cocktail information, gardening editorial and general news, it was available in large print and given to each person in the home. To keep all parties informed. The home was maintained well, and health and safety checks were undertaken, to ensure the safety of staff residents was maintained. Security gates were about to be fitted to help monitor access to the building and to prevent unauthorized persons gaining entry. Staff and resident meetings were held and minuted these were available. The manager was also creating relatives forum to ensure that everyone’s views were asked for and acted upon to ensure the home continued to provide a good service to all parties. A comment received from one resident was “ Anyone not happy here are hard to please”. Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 Page 21 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 Page 22 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. 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 Refer to Standard OP9 OP16 OP19 Good Practice Recommendations Medication balances received should be recorded. The complaints policy should state the Commission for Social Care Inspection not the National Care Standards Commission. This should be changed. The build up of dust behind the washer and dryers in the laundry should be removed. The outer laundry door should not in future, be held open by unauthorized means. Work identified should be completed to ensure the kitchen extractor fan runs quietly. The provider should endeavour to have 50 of care staff trained to NVQ Level 2 standard. Food hygiene training should be sourced for the one kitchen assistant who requires this. Receipts should be given for items purchased from the trolley shop. 4 OP28 OP30 OP35 5 Borrage House DS0000007958.V343645.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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