Inspection on 27/06/07 for Boucherne

This inspection was carried out on 27th June 2007.

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

Boucherne 15/12/09

Boucherne 27/07/06

Boucherne 03/11/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Boucherne Holloway Road Heybridge Maldon Essex CM9 4SQ Lead Inspector Francesca Halliday Unannounced Inspection 27th June 2007 09:30 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 Boucherne DS0000059320.V344492.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. Boucherne DS0000059320.V344492.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Boucherne Address Holloway Road Heybridge Maldon Essex CM9 4SQ 01621 855429 01621 854478 cjtibballs@btinternet.com 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) Boucherne Ltd Mr Christopher Tibballs Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Boucherne DS0000059320.V344492.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 24 persons) 27th July 2006 Date of last inspection Brief Description of the Service: Boucherne provides residential care for up to 24 older people. The home is situated in Heybridge, a short distance away from Maldon town centre. The period detached property has been extended to provide additional accommodation but has not lost it’s character and homely atmosphere. The home has a good-sized garden at the rear, with a smaller garden at the front. There is a small car park for visitors to the side of the property. Accommodation is on two floors, accessible by stairs, a passenger lift and a stair lift. Accommodation comprises both single and double rooms. All rooms seen were well furnished and decorated. Local shops are a short distance away and the home is on a bus route. The fees for the home, at the time of inspection in June 2007, ranged between £393 and £435 a week depending on the accommodation provided and the source of funding. Additional charges were made for newspapers, toiletries, hairdressing and private chiropody. For more up to date information contact the home directly. Boucherne DS0000059320.V344492.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place on 27th June 2007. The two owners were present throughout the inspection. A number of residents and staff were spoken with during the inspection. One relative was spoken with during the inspection and 4 were contacted following the inspection. Parts of the premises and a sample of records were inspected. The two owners, one of whom was the registered manager, had been managing the home on a day-today basis since the care manager resigned in April 2007. The new care manager was due to take up post in August 2007. What the service does well: What has improved since the last inspection? What they could do better: The owners were aware that the care documentation would benefit from development. Medicines management needed some improvements. The new care manager will be assessing and addressing staff training needs. Boucherne DS0000059320.V344492.R01.S.doc Version 5.2 Page 6 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. Boucherne DS0000059320.V344492.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 Boucherne DS0000059320.V344492.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) Quality in this outcome area is good. Prospective residents can expect to have a thorough assessment and assurances that their needs can be met prior to entering the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager or care manager carried out assessments for all prospective residents to ensure that the home could meet their needs. The documentation sampled was detailed and provided information about past medical history, abilities, interests and preferences as well as potential health and care needs. This information was on some occasions supplemented by a social services assessment. A resident who had recently been admitted to the home said that they had been made to feel very welcome and supported by both residents and staff and had settled in well. One of the owners said that potential residents and their representatives were encouraged to visit and spend time at the home before making a decision about admission. She stressed the importance of Boucherne DS0000059320.V344492.R01.S.doc Version 5.2 Page 9 involving the potential resident in the decision making process and ensuring that they were happy with the decision to move into the home. Boucherne DS0000059320.V344492.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 Quality in this outcome area is good. Residents receive high quality care person centred care. Medicines management is being reviewed in order to improve the safety for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents spoken with said that they had excellent care in the home and extremely good support from their GPs and the community nurses. One relative described the care as “exemplary”. The care plans were person centred and demonstrated a good understanding of residents’ preferences and abilities as well as their health and care needs. The owners were planning to develop the care plans further and encourage staff to make more use of them on a daily basis. Some of the daily care records provided evidence that staff were monitoring residents’ physical and mental health and gave a good indication of how they had spent their day, others were less informative. However, there was evidence from discussions with staff that they were monitoring residents’ health and care needs very closely. A discussion was Boucherne DS0000059320.V344492.R01.S.doc Version 5.2 Page 11 held about the benefit of keeping the daily care records in the individual residents’ folders, and linking the daily records more clearly to the care plans and to an evaluation of care and care needs. Risk assessments were seen but this was an area that needed to be developed. Residents said that a GP from the local practice attended the home one day every week and that GPs visited at other times when needed. Community nurses visited the home every day and community psychiatric nurses provided support when needed. Two chiropodists visited the home on a regular basis. Some residents visited the dentist and optician and others had dental and optical checkups in the home. There was evidence that residents were referred for hospital assessment and treatment when necessary. A number of relatives said that staff monitored residents’ health very closely and called the GP when necessary. Relatives said that staff had “excellent” communication with them and notified them very promptly of any concerns. The administration and recording of “as required” medication needed to be improved as the system in use did not provide a clear audit trail. Staff were reminded that medicines should not be left unattended and that they should only sign the Medicine Administration Record when the resident had taken their medicines. The storage of medicines needed to be reviewed as some medicines were being stored in the kitchen and some prescription only medicines were not being kept in a locked cupboard. The owners were advised to monitor the temperature of the storage areas at the hottest times of the day. Some Controlled Drugs (CDs) were not being kept in a CD cupboard. The owners were advised that a list of homely remedies should be agreed with the residents’ GPs and limited to medicines that were generally safe for all residents. The home had risk assessments for residents who were selfmedicating, but the assessment only covered whether the resident was physically able to administer but not whether they were competent and safe to do so. Care staff were observed to treat residents in a respectful and caring manner and to respect their confidentiality. Residents were extremely complimentary about the staff and said that they always respected their privacy and treated them with respect. Relatives confirmed that staff treated residents as individuals and upheld their privacy and dignity. Boucherne DS0000059320.V344492.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 Quality in this outcome area is good. Residents have a lifestyle that matches their expectations and provides choices and control over their lives. Meals are nutritious and well balanced. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A member of staff coordinated the range of activities in the home. The home also had a group, the “Friends of Boucherne”, made up of friends and family of current and previous residents. The Friends helped with numerous activities and outings and were a valuable asset to the home. A student on work experience was also involved in activities. The activities in the home included crafts, talks, a book group, slide shows, cooking, seated exercises, massages, flower arranging and trips to local places of interest. On Sunday there were pre-lunch drinks. Staff said that they tried to ensure that residents who preferred to spend time in their rooms or were bedridden also had individual time with staff. Residents said that they had very much enjoyed the recent garden party held at the home. People from the local community, as well as friends and family, Boucherne DS0000059320.V344492.R01.S.doc Version 5.2 Page 13 had also attended. Staff reported that the home had strong links with the local church and the local community. A communion service was held in the home once a month. One of the owners said that they were trying to contact the local Roman Catholic church for support as a resident of this religion had recently been admitted. Relatives said that they felt very welcome in the home at whatever time they visited. There was evidence that residents were encouraged and supported to maintain their independence for as long as possible. They actively participated in decision making within the home and chose how they spent their time. One resident said that the home was “free and easy” about what they did, where they spent their day and when they got up and went to bed. Residents said that there were always choices at mealtimes and described the standard of food as “good” or “excellent”. They said that alternatives would always be found if they did not like what was on the menu. Menus were set after consultation with residents individualy, and in meetings, and were varied throughout the year. Residents chose the menu on their birthday with help from the cook. Menus featured fresh produce, which was home cooked, varied and well balanced. Special diets were catered for. Boucherne DS0000059320.V344492.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 Quality in this outcome area is excellent. Residents have concerns addressed very promptly and are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints procedure, which was available to residents. All residents and relatives spoken with said that they had no complaints about the home. There was evidence that the home offered an open environment, in which residents felt very comfortable in expressing their views and expectations. Residents and relatives confirmed that any minor concerns were taken very seriously and addressed as quickly as possible. There was a strong ethos of person centred care in the home. Staff recognised residents rights to take risks in order to pursue their interests and to maintain their independance and wellbeing. Staff spoken with had an excellent understanding of the types of poor care practice that could be a form of abuse. Boucherne DS0000059320.V344492.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): Standards 19, 26 Quality in this outcome area is good. The home is clean and well maintained and offers residents a choice of communal areas. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was generally in very good decorative order and had retained a homely feel in the communal areas. The home had three day rooms and two dining rooms, which provided residents with choices about the type of communal area that most suited them (for example with or without television). Residents’ rooms were very well personalised to their tastes and preferences and many were obviously furnished with their own belongings. There were a number of paved areas in the gardens with chairs, tables with parasols and a summerhouse was available. Some of the residents had helped to plant up the colourful planters in the garden. The front garden had been developed with raised beds into a sensory garden. Boucherne DS0000059320.V344492.R01.S.doc Version 5.2 Page 16 There was a comprehensive cleaning schedule, which identified all areas to be cleaned in the home on a daily basis. The home was very clean on the day of this unannounced inspection with no unpleasant odours. The laundry had appropriate equipment including a washing machine with a sluice cycle. Residents said that they were very happy with the standards of the laundry service; one resident described the service as “excellent”. Boucherne DS0000059320.V344492.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): Standards 27, 28, 29, 30 Quality in this outcome area is good. Competent staff are deployed in a manner which matches residents’ changing needs. Recruitment procedures protect residents in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents and relatives were extremely complimentary about the staff. Residents described the staff as “wonderful” and a relative said “I can’t fault the staff”. The home had a very stable workforce and the majority of staff spoken with had worked at the home for a number of years. The rota demonstrated that care staff were deployed in a very flexible way in order to meet residents’ needs at different times of the day. There was one senior carer on duty from 07:45 to 15:30 plus four carers in the morning, and another senior carer from 15:15 to 22:30 plus two carers in the afternoon and from three to four carers at different times in the evening. Two carers were on duty at night with a manager on call. The home had a cook from 14:00 to 18:30 for six days a week. The carers prepared the breakfasts and light lunches each day and the cook prepared the main meals in the evenings. The home had a cleaner from 11:00 to 15:30 five days a week and carers carried out any additional cleaning required. Boucherne DS0000059320.V344492.R01.S.doc Version 5.2 Page 18 A high proportion of care staff had National Vocational Qualifications at Level 2 and level 3. A sample of staff records was inspected. There was evidence that all the required information had been obtained and a Criminal Records Bureau check had been completed. The home had a staff induction programme specific to the home. They were advised that they should model the induction on the Skills for Care common induction standards, in addition to the specific issues related to the home. The home had a proposed training plan. The owners said that the new care manager would be identifying and addressing staff training needs. Boucherne DS0000059320.V344492.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, 32, 33, 35, 36, 38 Quality in this outcome area is good. The home is well managed and run in the best interests of residents. Training is being organised to improve the safety of residents in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of inspection the home was being managed by the two owners one of whom was the registered manager. The previous care manager had left and a new care manager was due to take up appointment in the near future. A relative said that the owners were very approachable. Staff described the owners as very supportive. The owners provided a person centred environment where the emphasis was on providing homelike surroundings to suit the needs and wishes of the individual resident. It was evident that staff Boucherne DS0000059320.V344492.R01.S.doc Version 5.2 Page 20 acted as advocates for residents and tried to ensure, as far as possible, that residents could live their lives as they wished. The home did not have a formal quality assurance programme. Informal auditing was carried out on a regular basis. The home did not hold any personal money for the majority of residents. Any services such as hairdressing or chiropody were billed to the resident or their representatives. The owners handled the pension money for one resident. There was clear documentation for all transactions and the money was fully accounted for. However, the owners were advised that this money must be kept separate from any of the home’s finances. There were systems in place for an annual staff review. There was evidence of informal staff supervision but regular formal supervision had not been carried out since the last care manager had left. The owners said that this would be restarted once the new care manager took up the position. The owners said that they were planning to put guards on all radiators that were used and that risk assessments were in place for unguarded radiators. The owners were aware that a number of staff required updates and training in safe working practices. On the day of inspection staff were having moving and handling training and the trainer was reviewing the specific needs of residents who required moving and handling. The owners were advised that the home should have sufficient staff with first aid training to ensure that they had one first aider on duty at all times. The home had systems in place to ensure that all equipment was serviced and maintained appropriately. One of the owners was responsible for health and safety and carried out regular maintenance jobs in the home. Boucherne DS0000059320.V344492.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 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 3 X X X X X X 3 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 2 3 X 2 Boucherne DS0000059320.V344492.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. These requirements were discussed with the owners at the time of inspection. No. Standard 1. OP9 Regulation 13(2) Timescale for action Medicines must be stored away from 01/08/07 the kitchen in a locked cupboard. Controlled Drugs must be stored in a CD cupboard. The temperature of the storage areas must be monitored and action taken if temperatures exceed 25c. There must be a clear audit trail for each individual medicine in the home so that a check can be made that residents have received their prescribed medicines. Residents finances must be kept separate from the home’s accounts in order to provide transparency of accounting. The care manager must identify and address staff training in safe working practices in order that staff are fully up to date and safe in their care practices with residents. 01/08/07 Requirement 2. OP35 17(2) 3. OP38 13 18(1)(c) 01/11/07 Boucherne DS0000059320.V344492.R01.S.doc Version 5.2 Page 23 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 OP30 OP36 Good Practice Recommendations The Skills for Care common induction standards should be used as the basis for care related induction. Staff should receive regular formal supervision. Boucherne DS0000059320.V344492.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. Extracts may not be used or reproduced without the express permission of CSCI Boucherne DS0000059320.V344492.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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