Inspection on 27/05/09 for Bournedale House

This inspection was carried out on 27th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bournedale House 03/06/08

Bournedale House 27/07/07

Bournedale House 25/07/06

Bournedale House 22/03/06

Bournedale House 28/11/05

Bournedale House 21/03/05

Bournedale House 23/09/04

Bournedale House 27/02/04

Bournedale House 13/10/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

Key inspection report Care homes for older people Name: Address: Bournedale House 441 Hagley Road Edgbaston Birmingham West Midlands B17 8BL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janet Adams     Date: 2 7 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Bournedale House 441 Hagley Road Edgbaston Birmingham West Midlands B17 8BL 01214204580 01214204580 bournedalehouse@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr David Pangbourne Name of registered manager (if applicable) Ms Karen Smith Type of registration: Number of places registered: care home 11 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: 11 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 11 Dementia (DE) 11 Date of last inspection Brief description of the care home Bournedale House is located approximately 3 miles from Birmingham city centre, and within walking distance of Bearwood shopping centre. Facilities such as churches, public houses, restaurants, library and parks are close to the home. Care Homes for Older People Page 4 of 30 Over 65 0 11 11 0 Brief description of the care home Bournedale House is a large Victorian property providing accommodation to 11 older adults. Care is provided on the ground and first floors, a chair lift provides access to the first floor facilities. On the ground floor there is a main lounge, dining area and kitchen, with toilet and shower facilities within easy reach. The lounge is to the rear of the property, is spacious and provides nice views of the rear garden. There is a shared double room to the ground front of the property that provides accommodation for two people who require ground floor facilities. This room has privacy screens. The first floor facilities consist of single bedrooms with ample storage, some with original Victorian fireplaces. The bathroom and shower room are large enough to allow for staff assistance if required. There are grab rails located in toilets and around the home to aid people living in the home. The service user guide for the home did not include any information on the range of fees charged. Care Homes for Older People Page 5 of 30 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 service was last inspected on June 3, 2008. This report describes an inspection we carried out over one visit which lasted seven and a half hours. Some time before the inspection, we wrote to the home to request some up to date information to assist with this process. This meant that although Bournedale House knew the inspection was imminent, they were not aware of the date or time the inspection would take place. The inspection included observing activity within the home, inspecting the premises, an in depth look at records for residents and staff, as well as observing, talking and listening to the majority of the 11 people living there. The aim of the visit on the inspection day was to have a good look round the home, and to spend time observing people living there. Some of the staff on duty at the time of the inspection also shared their views about working at the care home. Discussions with people were carried out in private with people on their own, or together in groups Care Homes for Older People Page 6 of 30 in the lounges. Everyone was happy to share their comments, which are included in the main body of the report. As part of the inspection process we, the Commission circulated questionnaires and stamped addressed envelopes to people living visiting and working at the home, so their views and opinions could be included in this report. A total of 6 people using the service, 5 staff members and 5 relatives, carers and advocates returned their written comments about the service to us. No -one especially requested to speak to us in person. Everyone, including residents and staff, was very welcoming and helpful throughout the inspection. The care manager was thanked for the very useful information provided before the inspection and her assistance on the inspection day. Feedback about the conclusions of our findings was given at the end of the inspection. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: It is considered that Bournedale House is committed to raise its standards and is setting its own objectives for continual improvement with the full involvement of the people who use it. However, as a result of our inspection findings, one statutory requirement and a total of ten good practice recommendations have been made in order to improve standards at the service, which will further benefit people living and working there. Although the service attended to an unguarded radiator in a bathroom another without a guard it in a bedroom. The home need to make sure there are safety systems in place so there is no risk of contact burns when the heating is on. The information that is provided for people thinking about using the home needs to be updated with relevant details so people get a full picture of how the home can meet their needs. Although the majority of health needs of the people living at Bournedale House are met and people get the care from other professionals they need, the quality of details in the care plans of people living there need to be expanded.This will ensure staff know how Care Homes for Older People Page 8 of 30 to support them to meet their needs. Care paperwork lacked details about the specific levels of assistance required in relation to some medical conditions, peoples ability to make decisions and advice about moving them safely at all times. Some repairs were seen to be necessary in bedrooms we looked at. We were informed these were being addressed. The home is advised to review its infection control systems to make sure the right equipment is available at all times for hand washing. The way the home manages its clinical waste is also in need of improvement. Paperwork for people the home holds money in their safekeeping also needs to demonstrate their finances are double checked when accessed. Records for the fire drills for home carries out also require attention so that there are accurate details about staff who have been involved with this procedure. The above actions will ensure the well-being of people living visiting and working at Bournedale House are being promoted to the standards we expect. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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. People who use the service receive most of the necessary information to make a fully informed choice about what living at Bournedale House can offer. People have their needs assessed prior to moving in the home. This means they can be confident the home will be able to meet their needs. Evidence: The feedback we received from people about moving into Bournedale House was positive. All 5 people who completed our satisfaction survey told us they received enough information to help decide if this home was the right place for them before they moved in. Before our inspection the home sent us some information which told us, Bournedale make available to our service users an up-to-date statement of purpose which sets out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the home. We also provide a service users guide for current and Care Homes for Older People Page 11 of 30 Evidence: prospective residents. We provide services based upon consultation and assessment of the residents needs. In order to confirm what they told us was accurate, we looked at a copy of the information the home supplies to people thinking about living at Bournedale House, and the records of one person who had recently moved into the home. It was good to be told that people received up to date information about the home, however, upon examination of the homes Statement of Purpose and Service User Guide which we were given at the time of our visit to the home, it was seen to still be in need of an update. The information was dated 2006, and although it had the newly appointed care managers name on the front, it named another person to be the manager on the details inside the document. It also told the reader that our contact details was one of our offices that has been closed for 12 months, and in addition, it still lacked the information about fees we recommended Bournedale House include when we advised them to improve this information at our last inspection in 2008. Although this information has a section about the accommodation the home provides, it does not tell the reader the arrangements the home will carry out to make sure personal possessions are kept safe.Some bedrooms do do not have secure storage for their valuables and momentoes. The home is advised to update this information as a matter of priority. Examination of records the home keeps to show they can look after people properly if they decide to move in confirmed this had been done professionally. Paperwork showed that that the home management team obtain all the information they need from the person concerned and the people who are close to them as well as any professionals who have been involved in their well being. It is positive the home now formulate a chronology of details and information to account for the people they speak to as they explore a persons needs.This record had excellent information about visiting the person, contact with people involved in supporting the individual, and when family members viewed Bournedale House on the persons behalf. Care Homes for Older People Page 12 of 30 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. The care needs and risk assessments set out in the individual plans of care do not ensure that all peoples needs have been addressed and will be fully met. Medication management systems at Bournedale House require further development to ensure the people living there safely receive their medication as prescribed by their doctor. The actions of staff and their approach to care ensures that people are treated with respect and their right to privacy is upheld. Evidence: The people who live at the home and responded to our satisfaction survey all commented they received the right care and support, and that staff listened and acted upon their wishes. Two people wrote and told us that one of the things the home did best was to provide a good level of care. People also stated they were satisfied with their care and one person said, I am very happy here. People we spoke to confirmed they are treated with dignity and respect. We saw staff knocking on toilet and Care Homes for Older People Page 13 of 30 Evidence: bathroom doors before they entered, and they were seen to approach the people they offered care and support to in a respectful manner. Before we carried out the inspection visit, the home told us, All our residents where practical are involved in the planning and review of the our services that are provided for them to ensure that their needs are met.Staff are on duty to plan and supervise residents care, ensuring the highest standards at all times. In order to confirm this, the records of four of the people living at the home were looked at. It was not clear from the records we saw that people had been involved in their care planning for some time. The only information we could see was in one set of records that told us a person had been involved in this process in December 2007. Although the care records made reference to Deprivation of Liberty Safeguarding practices, none of the records we looked at confirmed whether people had the capacity to make decisions for themselves. As Bournedale House is registered to care and support people with dementia related conditions, this issue needs to be addressed as a priority. This matter was discussed during the inspection. At the last inspection a requirement was made for the home to improve its moving and handling assessments in order to offer people assurance they would be moved safely. Although this paperwork has improved, the records we checked for two people who had recent falls recorded in the accident book did not have enough information to offer staff guidance how to move the individuals safely in the event of any further falls. Care records also lacked evidence to confirm relatives being informed when anyone has an accident. Although the daily reports gave a good account of the care that was carried out records lacked specific details to guide staff how to support people with their medical conditions. The records of the person who had regular insulin to manage diabetes did not have information to advise staff what to do in the event of an emergency for this condition. Wrong wording in this persons records identified the individual may demonstrate incorrect symptoms. This matter was also discussed with the manager. It is positive the care records have been improved to account for peoples nutritional needs and their skin condition, however,this information also lacked the details expected to be recorded in them. The records of one person who had suffered injuries as a result of a fall did have not them accounted for on this paperwork. We reviewed the medication management systems in the home with the assistance of the manager and a senior carer. Records confirmed the home now regularly audit their medication stocks and it was seen that the service has a robust system to audit medication loosely stored in boxes. These are checked at the start and the end of each Care Homes for Older People Page 14 of 30 Evidence: shift.Spot checks confirmed that records of medication administration were accurate and reflected the stocks of drugs the home stored in its drug trolley. However, medication seen stored in the kitchen fridge which included insulin could not be fully accounted for. There were no records to confirm when this medication had been received into the home.In addition, the home was not maintaining adequate temperature records necessary for insulin storage. The manager was not aware this medication was being stored there.These matters were discussed in depth during the inspection. It was therefore positive to be informed that steps had been taken to improve these matters. It was reported a new drug supplier is in the process providing Bournedale with a new drug trolley fridge and controlled drug cupboard, alongside apporopriate staff training and information for this matter. Care Homes for Older People Page 15 of 30 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. The daily life and social activities arranged for people living at Bournedale House takes into account the differing expectations, preferences, lifestyle and abilities of each individual. Residents receive a healthy diet according to their assessed requirement and preference. Evidence: Feedback from residents who took part in our survey confirmed there are always activities planned that they can take part in, although two did comment they would like more outings. The information in the home sent to us before our inspection informed us more trips out were already being planned, and our discussion with the manager confirmed more activities were in the pipeline with outings such as theatre trips being on the agenda. We were told the home was already engaged in fundraising for future excursions. Comments we received from 5 relatives confirmed the visitors of the people who live there have a good rapport with the staff team, and they were always made welcome at Bournedale House. One person commented, Tthey always respond with good humour. This practice was reflected during the inspection when two relatives telephoned the home to speak to their family member. Care Homes for Older People Page 16 of 30 Evidence: The home was calm and relaxed throughout the inspection and the interactions between the staff and the people living in the home were good. people were seen to be engaged in a variety of one-to-one activities with the staff team, enjoying pastimes such as jigsaws and playing skittles. These pastimes were reflected in the daily records of peoples care plans. The records of one lady also accounted for shopping trips and some household chores she told us she enjoys.Another Person told us how she enjoyed joining in exercise sessions with staff to keep her fit. When people move into Bournedale House their cultural and spiritual needs are assessed and the manager told us these are explored and acted upon. Whilst having lunch with the people living at the home they were keen to tell us how nice the meals were. Everyone including those in need of special diets was complimentary about what they get to eat and drink. One relative also told us the food suited the folks perfectly. A menu board on display in the dining room acts as a prompt to remind people what they have on offer to eat.Observations we made at two different mealtimes confirmed staff on duty were knowledgeable about peoples dietary needs, and the best way to serve their residents food so they can dine independently.Detailed records seen kept in daily care reports accounted for the food and drink people enjoyed to keep them well. Care Homes for Older People Page 17 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the views of the people living at Bournedale House are listened to and acted on. Systems in place make sure people are protected from abuse so ensuring their well being. Evidence: All comments received from people living, visiting and working at the home were unanimous in that people knew what to do if they had to make a complaint. The home complaints procedure clearly describes what people have to do if they are not happy. This information is contained in the resident information mentioned earlier in the report. Auditing of the home complaints log book confirmed four minor complaints have been received since our last inspection and dealt with appropriately.Our records also confirm we also have not received any complaints about this service or had any referrals to the local safeguarding adults team since our last inspection in June 2008. Management improvements have continued to make sure people feel comfortable to raise any concerns they are unhappy about. Staff training has improved for this sensitive matter and the manager herself has undertaken training to train other people about this topic. It is positive people living in the home are involved in this training. One person regularly assists the manager with her training sessions. This positive practice confirmed the home is actively working to protect the well-being of the people that live there. Care Homes for Older People Page 18 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the service to live in a comfortable, clean, adequately maintained environment, which encourages independence. Evidence: Everyone we had contact with about the home confirmed their satisfaction about their living surroundings. One person also wrote and told us, The home is warm and friendly. Its like a family home not a residential home. if Our first impressions of Bournedale House confirm it is a welcoming place to live. It has been further improved with some signage to help people with memory problems find their way around and keep them independent. The statement of purpose we were given at the time of the inspection told us that, The home is a safe and secure place to live, and Bournedale House, provides each resident with A safe and secure place to store their valuables. Our inspection findings confirmed at least three people did not have any locking storage facilities in their bedrooms, and there was no reference to these peoples agreement to alternative arrangements for this matter in their care paperwork. The statement of purpose also informed us that all bedrooms are equipped with a call Care Homes for Older People Page 19 of 30 Evidence: system. One of the bedrooms we saw being used did not have this facility installed. This matter was discussed with the home manager because it means the person who uses this room does not have an effective way to communicate with staff when solely occupying it. Earlier in this report we commented that the home needs to make sure that peoples ability to make decisions is accounted for to keep them safe. Systems need to be developed to account for peoples ability to communicate and call for help if they need it, especially if they do not have the equipment to use for this matter or their ability to use this equipment is challenged. In the same bedroom, a leaking roof had resulted in extensive damage to the plasterwork and wallpaper under the window. This was damp and unsightly and was awaiting repair. The manager assured us this was being dealt with. In a bedroom that we saw occupied by two people, a radiator located under the window was not guarded. At the last inspection we made a requirement for the same reason for a radiator in one of the bathrooms. The management are strongly advised to fully audit the radiator provision in the home to make sure the heating provided by the home keeps people safe when it is in use. In June 2008 we also advised the home to audit the furnishings and fittings they provide in their bedrooms to confirm people were happy and safe with the facilities that had been provided for them. It was therefore positive to be told by the manager that a bedroom audit had been carried out the day before the inspection and remedial action had been identified to improve the personal space people occupy. Externally, the home have equipped a patio area for people to enjoy any good weather during the summer months. Residents of the home also have access to some land to the rear of the home to use for picnics and walks. The manager told us people have regularly used these facilities recently. All individuals who made comments to us about the home were in agreement that the home is always fresh and clean.The information in the home provided for us before our inspection also told us, Our home is clean,pleasant and hygienic, Policies and procedures are in place and are adhered by all staff. We were also informed that the home had used the Department of Health guidance to assess their infection control management.However,the arrangements for hand washing facilities we saw provided around the home did not reflect the good practice the home needs to follow. Several toilets and bathrooms lacked appropriate hand washing equipment, and in various locations throughout the home including the kitchen there was a lack of hot water for this purpose. Likewise there was a shortage Care Homes for Older People Page 20 of 30 Evidence: of foot operated pedal bins to dispose of paper towels for this process. Although the home had a plentiful supply of liquid soap and paper towels, this equipment had not been replenished for staff to access as they went about their morning duties. This matter was discussed during the inspection. Housekeeping systems need to be further developed to ensure staff have access to appropriate hand washing facilities at all times. Some parts of the home are showing signs of wear and tear and would benefit improvement with some essential maintenance. It was positive to be told carpets which were stained were in the process of being replaced. This will make the home more attractive and pleasant for the people living there. We were also told that some kitchen improvements recommended following a recent environmental health officer visit are also in hand. When we looked at the storage arrangements for clinical waste this was seen to be kept in unlocked domestic household bins not far from the kitchen area. This area had a lot of flies present, and the bins were in need of cleaning. This matter was also discussed at the time of the inspection. The service is advised to seek professional guidance about this matter to confirm this waste is being stored securely and effectively while it is waiting for collection. Care Homes for Older People Page 21 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing, their support and development ensure that the needs of the people living there are met. The recruitment practices help to ensure that the people living there are safeguarded from abuse. Evidence: Favourable comments received from people living at the home confirmed that they receive the care and support they require. One person commented, I find staff very kind and friendly. Examination of past, present and future rotas during the inspection confirmed the home is adequately staffed and takes into account the dependency needs and numbers of people living at the home. Since the last inspection the home has improved the staffing arrangements for night duty which to further benefit of the safety and well-being of individuals living there. Comments from the care team confirmed they are clear regarding their role and what is expected of them and they were happy in their job .One staff member wrote, I enjoy my job and enjoy working here. The home is proud there is a very low turnover of staff, if with and this means they do not use agency carers. As a result people get looked after by a staff team that knows them at all times. Care Homes for Older People Page 22 of 30 Evidence: Examination of the file for the latest recruit to the staff team showed that suitable screening procedures are in place.This paperwork was well-organised and contained references, proofof criminal record bureau disclosures and confirmation of identity and qualifications. Many aspects of staff training have been improved. Records show new starters get a proper introduction to working at Bournedale House and a training agreement is set up to make sure any development needs are attended to. If 97 of the carers have the minimum expected care qualification and 50 of staff are currently working towards attaining additional NVQ level 3 qualifications. Good tracker systems have been set up by the manager so she has an at a glance picture of the training staff have had and what they need. Records we saw confirmed that additional training we expect to see staff to undertake to work in a home registered to care for people with dementia related challenges was also in hand. Care Homes for Older People Page 23 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team is committed to improving the quality of the service. Systems for the health, safety and welfare for residents, staff and visitors continue to be improved to ensure they meet the changing needs of people living at Bournedale House and safeguard their well being. Evidence: The recently appointed care manager told us she has submitted her application for consideration to be registered with the commission for this responsibility. Throughout the inspection she demonstrated her enthusiasm, professionalism and commitment to this position. It is obvious she has a good rapport with people who live at the home, the people who were close to them, visiting professionals and the staff team. She has been supported in her role by the owner who regularly visits the home and monitors the management and well-being of people at Bournedale House. Systems have been improved to make sure everybody has the opportunity to have their say about how the home is run and a recent survey conducted by the home in early May confirmed Care Homes for Older People Page 24 of 30 Evidence: people were happy with the service Bournedale House provides. People commented, I am satisfied, very grateful and appreciative of the service the home provides. Another said, I have no issues with the home I am very happy with what they do. There were also excellent suggestions about improvements to the gardens. The manager told us these ideas were in the process of being shared and considered by the people who lived at the home. Prior to our inspection, the manager submitted an annual quality assurance assessment (AQAA) off of To tell us about Bournedale House. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. The AQAA contained comprehensive information with a wide range of supporting evidence, some of which was seen during the inspection. The AQAA demonstrated a satisfactory level of understanding about the importance of equality and diversity and a range of evidence showing how they have listened to people who use the service and the staff team. Through this information the service have demonstrated self awareness and identified the areas in which it still needs to improve. Discussions with the manager during the inspection gave evidence of how the improvements were to be achieved, including the issues we have recommended be prioritised in this report. Improvements to the safe working systems in the home have continued to ensure satisfactory management of monies and valuables kept in safekeeping for residents. The home have introduced a new system to audit this process. This could be further improved by making sure that there are two signatures for every financial transaction concerning the monies of a person living in the home. Many service and maintenance records for essential equipment used in the home were seen to be up to date and complied with necessary health and safety legislation,and as part of the in house safety monitoring, the staff also complete a monthly audit for accidents. This makes sure they are followed up properly, and any care paperwork is reviewed as part of this process. Upon checking the care records concerning this information it was discussed with the manager this could be further improved with more details to make sure the home recordkeeping confirmed it was doing all it can to keep people safe. Review of the home fire risk assessment confirmed this had been updated in January 2009. The manager also told us that the fire service was booked to visit the home shortly after the inspection for some goodwill and advice to improve this. It is positive that fire drills have taken place regularly, although recordkeeping for this needs to be improved so that it identifies which members of staff have taken part in this exercise. This will make sure the home can demonstrate whole team have been involved in this activity throughout the year. Care Homes for Older People Page 25 of 30 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 26 of 30 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 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 19 23 The home must ensure there 30/09/2009 are safety systems in place to make sure all radiators in use in the home are not a contact burn risk to the people who live there. This will offer assurance to the people who live at Bournedale House that the home is doing all it can to keep them safe. 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 1 The Statement of Purpose and Service User Guide should contain information about the service as per Schedule 1 and its associated Regulations. People thinking about moving into Bournedale House must be provided with all the necessary information they need to help them to decide whether the home is right for them. Care plans need to contain all the relevant information staff require to safely meet their needs especially with regard to any medical conditions they may have, and as their needs Page 27 of 30 2 7 Care Homes for Older People 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 change, especially in the event of an accident.This will assure people living in the home that the service is doing all it can tosafeguard their well being. 3 7 Care records of people living in the home need to contain details to confirm individuals capacity to be able to make their own decisions about their well being.This will assure people in the home that the service is doing all it can to involve them in making decisions which are in their best interests,to safeguard their wellbeing. The details on manual handling risk assessments need to describe any handling methods and equipment to be used by staff, especially in the event of a fall. This will offer people assurance their well being is being addressed at all times. In order to confirm the home is safely storing any medications people require to be kept in the refrigerator, the home is advised to obtain a thermometer which can enable them to record minimum and maximum temperatures. These must be recorded daily. This will offer assurance to people in the home that their well-being is being promoted. The home management are advised to ensure any necessary remedial actions identified following their recent bedroom audit are carried out so that people can live as independently as possible in rooms which are safe and comfortable and suited to their needs. Housekeeping arrangements in the home need to be further developed to ensure an adequate supply of hot water and hand washing equipment is available at all times. This will ensure the well-being of all people living at the home is being safeguarded by its robust infection control systems. The service is advised to seek appropriate professional advice to manage the safe and secure disposal arrangements for clinical waste the home generates. This will ensure people living at the home will not be exposed to any unnecessary risk. It is strongly advised that the service further develop the way they manage the money of people living in the home by making sure they are always two signatures whenever there is a financial transaction on behalf of a person. This Page 28 of 30 4 7 5 9 6 23 7 26 8 26 9 35 Care Homes for Older People 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 will make sure there are robust records of financial transactions of the monies of people living in the home and thus safeguard their financial well-being. 10 38 Recordkeeping for fire drills carried out in the home is advised to be further developed thought that the service can account for the names of the staff involved in this procedure. This will make sure that records can confirm all staff have been involved in this activity to safeguard people in an emergency evacuation situation. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - 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!