Inspection on 26/11/08 for Boughton Lodge

This inspection was carried out on 26th November 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Boughton Lodge 105 Boughton Green Road Kingsthorpe Northampton NN2 7SU     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Catherine Perrins     Date: 2 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Boughton Lodge 105 Boughton Green Road Kingsthorpe Northampton NN2 7SU 01604720323 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Kingsthorpe Care Ltd care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 13 The registered person may provide the following categories 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 Date of last inspection Brief description of the care home Boughton Lodge was originally registered in 2000. It was bought by the current owners in May 2008. The current registered manager was the registered manager prior to the new owners buying the home. The home is a large detached property in a residential part of Kingsthorpe, not far from local amenities. The home has two double bedrooms with the rest all being single. There is a communal lounge, sitting room and snug. Adjoining the home there is a small flat where one person lives semi independently. Current fees for the home are 385 pounds a week. 13 0 Over 65 0 13 Care Homes for Older People Page 4 of 27 Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection. We looked at all of the key standards and some additional standards. These are detailed in the report. The registered manager was present for most of the inspection which lasted for six hours. A limited tour of the premises was conducted which involved viewing the communal areas and a selection of the private accommodation. Case tracking is the method used during inspection where all aspects of peoples care and experiences was reviewed,including individual plans of care and associated Care Homes for Older People Page 6 of 27 documentation. Three people were case tracked during this inspection. The views of people who live at the home were sought be talking to people during the inspection and by surveys returned to the Commission for Social Care inspection. Some staff members were also spoken to as part of the inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 27 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 assessed prior to moving into the home to ensure that their needs can be met. Evidence: The home has a statement of purpose and service user guide although these need updating to detail the new owner and to give correct address of the Commission for Social Care Inspection. Records show that people have an assessment prior to moving to the home. The registered manager explained that before moving in people are invited to visit and have a meal. They are then assessed to ensure that the home can meet their needs. The manager told us that the persons care manager is involved in this assessment. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 live in this home appear to have their individual needs and choices met but recording systems do not accurately reflect this. Evidence: Each person living at Boughton Lodge has an individual plan of care. These contain their initial assessment along with care plans and risk assessments to give staff the information they need to care for people safely and in the right way. Individual plans of care contain some details of peoples preferences for example their preferred name and the food and drinks that they like and dislike. There is some information about peoples health care needs recorded in their individual plans of care for example details of pressure care, moving and handling, nutrition and catheter care. Where people had specific health care needs, for example due to diabetes or anticoagulant drug therapy this was not consistently recorded in their individual plan of care. This means that staff may not have all the information about Care Homes for Older People Page 12 of 27 Evidence: how their needs should be met. Individual plans of care do not consistently record information about when people see health professionals for example podiatrists, ophthalmics, district nurses and medication reviews. In some instances these were recorded in peoples daily notes, in the homes diary or on a loose leaf piece of paper within a generic file for all residents. It is important that this information is easily accessible to ensure that people are having the necessary health checks. Regular podiatry and opthalmic checks are specifically important for people with diabetes. The date of entries in peoples daily notes does not consistently record the year, recording just the date and month. The current arrangements for the storage of controlled drugs at the home does not meet the latest requirements of the Misuse of Drugs Act Amendment 2007. At a follow up visit to the home on 8th December, 2008 the registered manger stated that a controlled drugs cupboard has been ordered. Controlled drugs are prescribed medicines which some people abuse them by taking them when they have not been prescribed. There are laws and regulations about how these drugs should be stored and administered. A spot check of the medication showed that there were two tablets missing from the blister packs with no explanation recorded on the medication administration record or in the persons individual plan of care. One of the tablets that was missing was a controlled drug. Some signatures were missing from the medication record for two other people. It is important that the home accurately records all medication received and administered to ensure that people are receiving their medication as prescribed. An immediate requirement was issued to the registered manager to ensure that medication is administered and recorded accurately, safely and as directed. We issue an immediate requirement where we feel there is an immediate risk to someones safety. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 enjoy a good quality of life in a homely environment. Evidence: Records stated that people enjoy doing a range of activities including gardening, reminiscing, quizzes and board games. One person said, We play games like I spy or bowls. We all get on well together. All friends. Another person said, Everybody is involved, you dont get pushed out. A hairdresser was visiting the home on the day of inspection. One person said that they enjoyed,very good food. Menus viewed included a traditional hot meal at lunch time such as steak pie or toad in the hole served with fresh vegetables. Tea consists of a lighter meal or sandwich. On day of inspection lunch was the registered manager was preparing roast chicken, roast potatoes, broccoli, peas, leeks and carrots for lunch followed by fruit cocktail and ices. One person said that she likes to help in kitchen. After lunch people were observed relaxing in the lounge. One person commented We Care Homes for Older People Page 14 of 27 Evidence: can have a glass of sherry if we want. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Inconsistent record keeping within the home means that peoples safety cannot be guaranteed. Evidence: The homes complaints policy was viewed. No complaints or safeguarding allegations had been made since the home has been registered to the current provider. Staff spoken to said that they would raise any concerns through the homes complaints procedure. Records show that not all staff have received training on the safeguarding of adults. Some concerns regarding protection have been raised in other sections of this report and relate to recruitment practices and the administration of medication. Care Homes for Older People Page 16 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 enjoy a comfortable, well maintained and homely place to live. Evidence: Boughton Lodge is a large detached property not far from the centre of Kingsthorpe. The property consists of a large communal lounge, a communal dining room and a small snug which is used as a quiet area. Two of the bedrooms are doubles with the rest all being single. The property was very clean and well maintained throughout. Carpets in some of the bedrooms were being cleaned on the day of inspection. The statement of purpose says that the home aims to provide a home from home. One person who lives at the home returned a survey to us which stated Its like home. Pictures and ornaments add to the homely feel and the layout and decor of the property is more like a domestic home than a care home. People are encouraged to personalise their bedrooms. One person said My bedroom is comfy, Ive got everything I want. The home has a garden with seated area, people said that they sit outside in the warmer weather. Care Homes for Older People Page 17 of 27 Evidence: Adjoining the home there is a self contained flat where one person is able to live more independently but with the support of care staff when he needs it. The registered provider plans to extend the home to accommodate further bedrooms and communal areas. Care Homes for Older People Page 18 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff care for residents with respect and sensitivity however inconsistent pre recruitment checks mean that peoples safety is put at risk. Evidence: Staff spoken to showed a good understanding of peoples care needs. One person who lives at the home said, Staff are very helpful, you can ask them anything. One staff member said I am really attached to residents - we are like a family. Staff explained that their induction consisted of shadowing an experienced staff member, spending time with the registered manager and attending training courses. Records show that staff attended training in infection control, Liverpool pathway for end of life care, moving and handling and health and safety. Records show that pre recruitment checks are not consistently carried out. For example one person only had verbal references and no reference from their last employer. Another persons criminal record bureau check had been done by their previous employer and not by the home. Another persons criminal record bureau check showed that a POVA list check has not been requested. The POVA (Protection of vulnerable adults) list is a national database of people who should not work with older Care Homes for Older People Page 19 of 27 Evidence: people and other potentially vulnerable adults. The registered manager stated that she believed all the checks to have been done. The home needs to ensure that all pre recruitment checks are done prior to a staff member starting work, this is necessary to ensure that all the staff who work at the home are safe to work with older people. Care Homes for Older People Page 20 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Records do not reflect what people tell us about the good standard of care that they enjoy at the home. Evidence: The registered manager explained that although she had been the registered manager prior to the current provider buying the home the previous provider used to deal with much of the record keeping. She stated that she was still in the process of updating some of the records. A number of issues relating to poor record keeping have been hilighted throughout this report and requirements and recommendations made to tell the registered manager and provider the actions that they need to take to ensure that record keeping meets the necessary regulations. It is important that the record keeping is improved if it is to reflect the good standard of care and satisfaction that people who live in the home say they enjoy. Staff and residents spoke highly of the registered manager. One person said in a Care Homes for Older People Page 21 of 27 Evidence: questionnaire that we sent to them, I knew this was the place I wanted to live as soon as I looked round. Everywhere looked clean, homely and the staff and manager were lovely. A questionnaire sent out by the registered manager in April 2008 showed people to be very satisfied with food, the care they received, the premises and the management of the home. The registered manager explained that residents meetings are held regularly to discuss issues concerning the running of home. Records show a regular maintenance program including fire checks, servicing for bath lifts and the stair lift and electrical checks. Radiator covers are in place throughout the home and hot water restrictors are fitted to baths to ensure that people do not get burned or scalded. There was no record of legionella checks being carried out. This involves regular checks on the water system. Care Homes for Older People Page 22 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 Medication must be stored, administered and recorded accurately, safely and as directed. To ensure people receive their medication as prescribed. 29/11/2008 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 An up to date Statement of purpose must be available which includes all of the information detailed in regulation 4 and schedule 1 of the Care Homes Regulations 2001. To ensure that people have accurate information about the home. 31/03/2009 2 1 5 An up to date Service User Guide must be available which includes all of the information detailed in regulation 5 of the Care Homes Regulations 2001. To ensure that people have accurate information about the home. 31/03/2009 Care Homes for Older People Page 24 of 27 3 7 15 Peoples needs in relation to any specialist health care must be recorded in their individual plan of care. So that staff know how to care for them in the right way. 31/03/2009 4 29 19 All pre recruitment checks must be carried out before staff commence work at the home. This includes a Criminal Records Bureau Check, a POVA check and two written references. To ensure that staff are suitable and safe to work with older people. 31/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 All entries official documentation must be dated with the date, month and year of the entry to ensure that information is accessible should it be needed at a future date and to ensure compliance with legislation on the retention of documents. Information pertaining to any individual should be recorded in their individual plan of care to ensure compliance with the Freedom of Information Act 2000. All staff should receive training in the Safeguarding of Adults to ensure that they are aware of their responsibilities under the locally agreed multi agency safeguarding arrangements. Staff records should include a training profile for each person to show what training they have received / require. Staff training should reflect the needs of the people who live at the home and include areas such as dementia care and diabetes. The home should carry out the necessary checks on the 2 7 3 18 4 5 30 30 6 38 Care Homes for Older People Page 25 of 27 water system to reduce the risks of legionella. Care Homes for Older People Page 26 of 27 Helpline: 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 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. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!