CARE HOMES FOR OLDER PEOPLE
Borrage House 8 Borrage Lane Ripon North Yorkshire HG4 2PZ Lead Inspector
John McGarva Unannounced Inspection 7th February 2006 10:00 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.V274143.R02.S.doc Version 5.1 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.V274143.R02.S.doc Version 5.1 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 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.V274143.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 07/09/05 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 was a private dwelling house and built on 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 vertical lift to provide level access to the first floor. It is located near the centre of the city of Ripon and there is ample garden and parking space to the side and rear of the main property. Borrage House DS0000007958.V274143.R02.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection, which took place on Tuesday 7th February 2006 and Mrs Alison Fagg, Senior carer, was available throughout to assist with the process. The inspection commenced at 10.00hrs until 13.00 hrs, 3 hrs in total. There were 36 residents in the home. The inspections focused on issues raised at the last inspection and the general management of the home. An inspection of some of the residents’ rooms, lounges and other communal areas as well as the medication room also took place. Discussion took place with Mrs A Fagg, Mrs I Poyle, administrative support, care staff and residents. The residents appeared content, were well dressed and some able to give good accounts of their impressions and experiences of the home and these were universally favourable. What the service does well: What has improved since the last inspection?
The issues surrounding the keeping of the accident forms has been addressed. The storage of the medications has been greatly improved with the provision of a dedicated room together with new cabinets, trolleys and drug refrigerator. The fire alarms are tested on an announced basis weekly and there is also an unannounced monthly test.
Borrage House DS0000007958.V274143.R02.S.doc Version 5.1 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. Borrage House DS0000007958.V274143.R02.S.doc Version 5.1 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.V274143.R02.S.doc Version 5.1 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 the following standard(s): These standards were not inspected on this occasion. EVIDENCE: Borrage House DS0000007958.V274143.R02.S.doc Version 5.1 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 the following standard(s): 8 and 9 The home should ensure that the residents correspond to the registered categories for the home. There are now improved arrangements for the storage and administration of medications. EVIDENCE: During the inspection, it emerged that a resident was in hospital as management problems had arisen due to the residents mental health problems. Staff spoken to indicate that in cases where residents mental health has deteriorated they were not always, or sufficiently promptly referred to other homes registered to care for them. This can put additional stress and work onto the staff that have not been trained to deal with such cases. The residents generally are becoming increasingly physically frail and this has also put greater demands on the care staff. The arrangements for the storage of the medications has been much improved with the provision of a medication room with sink, work surfaces and drug fridge. Borrage House DS0000007958.V274143.R02.S.doc Version 5.1 Page 10 The 28-day blister pack system (Manrex) is in use and is supplied by a major pharmacist who has also provided new medication trolleys, a drug refrigerator and cupboards. A larger controlled drug cupboard has also been ordered. The room is not ventilated and, with the heat emanating from the fridge, it will get warm in the summer months. As there is an external wall, a ventilation grill could be installed if thought necessary in the future. The controlled drugs of one resident was checked against the records and found to be correct. Identified care staff has received training in the administration and storage of medications. Borrage House DS0000007958.V274143.R02.S.doc Version 5.1 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 the following standard(s): 15. The dietary needs of users of the service are met with a varied menu of food being offered that satisfies the residents tastes and choices. EVIDENCE: The residents have choices of the main meals of the day as well as alternatives should they wish it. The residents confirmed that the meals provided were of a high quality. The head cook goes round the residents to help him be aware of the particular likes and dislikes of the residents. The kitchen is of a high standard in layout and decoration. There are stainless steel surfaces throughout as well as shelving and cupboards. The refrigerator and freezer temperatures are checked and recorded twice per day. The standard of cleanliness, tidiness and atmosphere in the kitchen indicated a high standard of leadership and commitment from the head cook who confirmed that his job ‘was a vacation’. Residents confirmed his attentiveness in their dietary needs. Borrage House DS0000007958.V274143.R02.S.doc Version 5.1 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 the following standard(s): These standards were not inspected on this occasion. EVIDENCE: Borrage House DS0000007958.V274143.R02.S.doc Version 5.1 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 the following standard(s): These standards were not inspected on this occasion. EVIDENCE: Borrage House DS0000007958.V274143.R02.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 and 30. Employing permanent staff continues to be a problem for the home. Progress has been made in the NVQ training programme. EVIDENCE: There has been quite a turnover of staff in recent times and dependence on agency staff is fairly high with four nights where only agency staff is deployed. Only two staff, one working 3 nights, the other 1 night is directly employed by the home during the night time period. Two care staff are deployed during the night shift and with up to 40 residents, together with their increasing dependency, this is one issue that needs to be discussed with the staff to ensure that the residents increasing needs are recognised. There is six care staff with NVQ Level 2 qualifications, which represents 38 of the total so trained. Another three have embarked upon the training and when completed, and noone else leaves, 56 of the staff will be so trained thereby more than meeting the required 50 CSCI standard. Regular statutory training in Fire safety, Moving & Handling and First aid take place. One member of staff said she “had not received training for a long time”. The care staff indicated they require more training in the management of dementia and Abuse and Protection of Vulnerable Adults. (POVA) Some training is planned in dementia care in the near future.
Borrage House DS0000007958.V274143.R02.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32 and 38. An appropriately trained manager manages the home. There are systems in place to ensure that the Health & Safety of the residents and staff are protected. EVIDENCE: The manager has been in post that has had many years in caring for the elderly and also has gained the Registered Managers award. A meeting had taken place with the staff on the previous Thursday 2nd February and previous to this in October 2005. More frequent meetings would help to keep the staff involved and consulted about the running of the home. Staff spoken to had not seen the last CSCI inspection report. The accident forms are now kept with the resident’s own files. The fire alarms are tested on an announced basis weekly and there is also an unannounced monthly test.
Borrage House DS0000007958.V274143.R02.S.doc Version 5.1 Page 16 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 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 1 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x x x STAFFING Standard No Score 27 2 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 x x x x x 3 Borrage House DS0000007958.V274143.R02.S.doc Version 5.1 Page 17 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 OP8 Regulation Requirement Timescale for action 01/03/06 Care Only residents within the Homes act registered category for the home must be admitted and remain in the home. 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 OP9 OP27 Good Practice Recommendations The temperature of the medication room should be monitored. The provider should review the numbers of staff to ensure that there is enough to meet the increasing dependency of the residents. The numbers of night staff should be reviewed. The provider should endeavour to have 50 of care staff trained to NVQ Level 2 standard. More regular training in care and POVA issues should be provided for the care staff. The staff should be consulted about developments in the home and more regular meetings would assist with this. The CSCI inspection reports should be made available for the staff to see.
DS0000007958.V274143.R02.S.doc Version 5.1 Page 18 3 4 5 OP28 OP30 OP32 Borrage House Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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