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Inspection on 02/03/09 for Boynes Nursing Home, The

Also see our care home review for Boynes Nursing Home, The for more information

This inspection was carried out on 2nd March 2009.

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

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Boynes Nursing Home, The Upper Hook Road Upton-upon-severn Worcestershire WR8 0SB     The quality rating for this care home is:   two star good 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: Amanda Lyndon     Date: 0 2 0 3 2 0 0 9 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. 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. 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 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Boynes Nursing Home, The Upper Hook Road Upton-upon-severn Worcestershire WR8 0SB 01684594001 01684594812 matron.theboynes@stcloudcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : St Cloud Care Plc care home 40 Number of places (if applicable): Under 65 Over 65 0 40 0 dementia old age, not falling within any other category physical disability Additional conditions: 20 0 40 The maximum number of service users to be accommodated is 40. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 20 Old age not falling within any other category (OP) 40 Physical Disabiltiy (PD) 40 Date of last inspection Brief description of the care home The Boynes Nursing Home is a country house in a rural setting, with views of the Malvern Hills and surrounding countryside. Private transport is required to access shops and other facilities. The home has recently undergone a major refurbishment and extension. The home offers nursing care for up to 40 people and 20 of these people may also have dementia care needs. There is a separate unit for people who have dementia and a sensory garden in this area. There is also large grounds Care Homes for Older People Page 4 of 33 Brief description of the care home surrounding the home for people to enjoy. There are communal lounges, dining rooms and specialist bathrooms. The home offers single accommodation and the vast majority of rooms have an en suite facility. There is a passenger lift to all floors. Ample off road parking is provided. There is equipment available to assist people to move around the home. The home operates a no smoking policy within the building. Current fee rates are available from the home on request. Items excluded from the accommodation fee include private chiropody, hairdressing and personal toiletries. A copy of our last report was available in the home. Care Homes for Older People Page 5 of 33 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: two star good 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: The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice ,and focuses on areas that need further development. The last key inspection at the home was 10th December 2007 and the registered manager had only been in post for one week at that time. Prior to the visit taking place, we looked at all the information that we had received or asked for since the last inspection. This included any complaints made or notifications received from the home. These are reports about things that have happened in the Care Homes for Older People Page 6 of 33 home that they have to let us know about by law. We received an Annual Quality Assurance Assessment AQAA. This tells us how the home think they are performing in order to meet the needs of people living there. We sent out random questionnaires to ten people who live at the home and ten staff, in order to obtain their views about the service provided. Seven people who live at the home, the majority with the help of their family and friends, and four staff returned questionnaires to us. Comments received are included in this report. The visit to the home was undertaken by one inspector over one day and we the commission were assisted throughout by the registered manager. The home did not know that we were visiting. There were 38 people living at the home on the day of our visit. Two people were case tracked and one file was partly reviewed. Case tracking involves discovering peoples experiences of living at the home and focuses on the outcomes for these people. In this instance due to the communication needs of people living there it was not possible to ask them for their views on the home, so time was spent observing care practices and speaking to staff about the care they provided to these people. We looked around some areas of the home and sampled care staff and health and safety records. No immediate requirements were made at the time of this visit. This means that there was nothing urgent that needed to be done to make sure people stayed safe and well. What the care home does well: What has improved since the last inspection? All previous requirements had been met which demonstrates that the management team are keen to improve the service provided to people there. The opening of the dementia care unit has meant that people with dementia care needs can be supported in a comfortable environment in which they are safe and secure. Staff had undertaken training about dementia so that they should have up to date knowledge and the skills to provide a good standard of care in this area. People are involved in the planning of their care so that they should receive care and Care Homes for Older People Page 8 of 33 support in the ways that they prefer. People are presented with appetising meals so that mealtimes should be an enjoyable experience. Efforts are made to ensure that the home is kept clean and fresh at all times so that people benefit from living in a clean and hygienic home that meets their needs. Recruitment practices have improved so that people can be confident that they are looked after by people suitable to work with older adults. People told us: The home provides a comfortable and cheerful environment. What they could do better: 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 set out 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 33 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 33 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 before they move into the home, so they can be confident their needs will be met there. People have all information required in order to make a decision about whether they would like to live at the home. Evidence: Feedback from the surveys completed prior to our visit, identified that the vast majority of people living at the home or their families felt that they had received enough information about the home before they moved in, so that they could decide if it was the right place for them. The statement of purpose was available in the home for people to refer to. It was informative, easy to read, and produced in a large print format. The registered manager stated that this could be produced in other formats and languages on request, so that everyone could access the information. Care Homes for Older People Page 11 of 33 Evidence: Information in the AQAA stated that each person will be given a service user guide for their room, and a home information pack, however we did not see evidence of this. A copy of the service user guide was not given to us on request. The registered manager stated that the range of fees incurred to live at the home were not included within this document. Information about fees is available from the manager and she stated that the costs incurred for an individual to live at the home is based on the cost of staff time to care for that person. Senior staff undertake comprehensive pre admission assessments for prospective people, in order to establish whether their care needs could be met at the home. We looked at the pre admission assessments for the people case tracked. A system for sending out written confirmation to prospective people so they knew that their care needs could be met at the home had not been introduced, however the registered manager stated that she does this verbally. People are encouraged to visit the home and have a meal or drink in order to sample what it would be like to live there. A contract was sampled for the person who had most recently come to live at the home. This included details of her room number and all costs incurred to live there. This means that she has agreed to these terms and conditions. Intermediate care is not provided at The Boynes. Care Homes for Older People Page 12 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Written records provide staff with the vast majority of information so that the health and personal care needs of people living at the home are met. Evidence: Since our last visit, staff had undertaken training about care planning, and it was evident that good progress had been made regarding the content of care plans at the home. Assessments of peoples individual physical and social care needs are undertaken on admission to the home, and care plans are derived from this information. These are individual plans written with the involvement of people and their representatives about what people can do for themselves and in what areas they require support. The majority of care plans sampled now contained personalised information about peoples preferences and the specific support required from staff. This should ensure that they receive care in the ways that they prefer. For example, care plans for communication needs gave good detail about the non verbal ways in which a person was able to communicate so that the staff would be able Care Homes for Older People Page 13 of 33 Evidence: to determine her needs, for example, if she was in pain. A care plan for a person who had a pressure sore (a skin wound that it caused from the person being immobile), identified the wound dressings being used for this. This means that the nursing staff could continue with the prescribed treatment, thus promote wound healing. On person had lost weight recently and there was evidence that a risk assessment had been undertaken. The person had been weighed on a weekly basis and the Doctor had been informed of this. In addition to the care plan the staff had written shortened versions called summarised care plans. The idea was that staff could refer to these if they needed any key information instead of reading through the full care plans. It was noted however that both of these sampled contained out of date information and may prevent people from receiving the care they require. All staff met during the visit however, had a good understanding of peoples individual care needs. The registered manager stated that she had recently held a meeting with the care team to discuss the importance of accurately and comprehensively completing daily care records, for example, food and fluid intake charts. Records sampled during the visit gave good detail about the type and amount of food and fluid taken by a person, so that an assessment of their intake could be undertaken. Care reviews are undertaken with people living at the home, their families and the home staff, in order to assess whether their care needs are still being met there. We saw evidence that details of these are documented within the home. Daily records included good information about the daily lives of people and the care provided for them. One daily record identified that a person had become aggressive, however a care plan had not been written. This may prevent the person from receiving the support that they require to minimise this behaviour. Staff met during the visit however, told me that they had a good knowledge of this persons needs. We sampled a care plan for another person that displayed behaviour that was challenging to others, and this gave good detail about possible trigger factors for these behaviours, and ways in which the staff can reduce the risk of them occurring and minimising behaviour that has occurred. Moving and handling risk assessments are undertaken so that the staff should know how to transfer people safely. We were told by staff and saw in daily care records that a person living at the home was transferred using a stand aid hoist at times depending Care Homes for Older People Page 14 of 33 Evidence: on his physical health. This information had not been included in the moving and handling assessment and there was no evidence that an assessment had been made to ensure that this type of hoist met his needs. This poses a risk to the health and safety of both the person and the staff team. We saw that people have access to a range of health and social care professionals and staff provide support and follow instructions given by these people. People can retain their own doctor on admission to the home if the doctor is in agreement. Otherwise the staff provide support to ensure that people are registered with a local doctor. Medication administration charts sampled were well maintained and medication audits are undertaken regularly. This should mean that people should receive their medication as prescribed and any errors regarding the management of this are identified and rectified. A comprehensive audit had recently been undertaken by the Pharmacy Area Manager for Worcestershire Primary Care Trust, who identified a poor practice regarding a controlled drug. No one had been harmed as a result of this however the nursing staff team had failed to follow the correct procedures for the management of this drug. The registered manager notified us of this at the time of the incident and a full investigation had been undertaken by senior managers. Actions had been taken to reduce the risk of an incident of a similar nature from occurring again. The gender mix of staff reflected that of the staff team so that people had a choice of the gender of staff chosen to assist with their personal care needs. We saw that a question had recently been added to the pre admission assessment to find out whether people had any preferences in this area. People appeared to be well supported by staff to choose their preferred clothing appropriate for the time of year their age, gender, and culture. Staff were observed to assist people in a respectful manner for example when using the hoist and this maintains their dignity. Some people choose to have a private telephone line in their bedrooms while others use the homes portable phone so that they can make and receive calls in private. People have the option of having a key for their bedroom door so that they can keep their personal items secure. The registered manager stated that no one chooses to do this at the current time. We saw that a bedroom door had been left wide open whilst the occupant was in the lounge and lockable storage was not provided in this room. Other bedroom doors had also been left open when the rooms were unoccupied however lockable storage was available in some rooms and there had not been any incidents of personal items going missing. This needs to be reviewed as current arrangements does not respect peoples privacy and means that personal belongings are left unsecured. Care Homes for Older People Page 15 of 33 Evidence: One person living at the home met during the visit said I am very happy and well cared for. One staff member who completed a survey prior to our visit said We try to meet the needs of all individuals and take into consideration every person in our home. We respect their and their families wishes. Care Homes for Older People Page 16 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities provided do not meet the needs or preferences of all people living at the home. People are confident that they can exercise some control over their daily lives. Evidence: There are two part time diversional therapists employed at the home to provide activities for people living there. Since our last visit, training had been given about providing activities suitable for people with dementia, in order to promote their well being and quality of their daily lives. Activity records were well maintained and included an evaluation of the success of each activity. Peoples verbal and non verbal responses to individual activities provided were recorded, and analysed in order to plan for future events. Recent activities included entertainers, one to one chats, games and handicrafts. During our visit we saw that staff were escorting two people on a trip around the garden, and a number of people had a newspaper of their choice delivered to them. A hairdresser visits the home each week and there is a hair salon within the home, so that people can enjoy the experience of going there if they choose to do so. There was an activity plan on display however this was out of date. This will prevent people from choosing which Care Homes for Older People Page 17 of 33 Evidence: activities they wish to take part in. Comments received from surveys completed by people living at the home regarding activities provided were mixed. The majority of people said that there were sometimes activities arranged by the home that they could take part in. One person said I find that some activities offered are not really what I need. Another person said I never take part in activities as bed bound. A review of this should be undertaken in order to meet the needs interests and expectations of all people living at the home. Peoples preferences regarding their religion are supported and respected. Holy Communion is held at the home each month. The registered manager said that she is trying to arrange for a church service to be held at the home. She stated that no one chooses to go to church at the current time. People can choose the times that they get out of bed and go to bed and where they choose to spend their day. There is an open visiting policy and people have a choice of where they entertain their guests, so that they can meet in private if they wish. Families can have a meal at the home for an additional charge, and people can go out with their friends and families if they choose to do so. This should ensure that people living at the home maintain relationships with those people important to them. The menus had been reviewed recently and identified a choice of nutritious meals. Much of the food is homemade, and cakes are made for people living at the home to celebrate special occasions. Snacks were available throughout the day and night so that people would not be hungry. We spoke to the Head Chef and she had a good knowledge about peoples dietary likes and dislikes. She told us that extra calories are added to the meals of people who are deemed to be at risk of losing weight. Special diets are prepared for reasons of health or cultural/religious preferences. At the present time diabetic meals are being prepared and finger foods in order to encourage people with dementia to eat well. Five people deemed to be at risk of choking required their food to be pureed, and the portions of these were prepared separately. This means that people can experience the taste and texture of each part of their meal. The main lunch time options on the day of the visit were either fishermans pie or mushroom omelette, with creamed macaroni for dessert. People had a choice of meal and if they did not like either of these options, they have the choice of other meals which are always available within the home. Food was well presented and plate covers were being used so that food should be served at the correct temperature. We saw that lipped plates and adapted cutlery were being used by a number of people as this promotes their independence and dignity during mealtimes. Staff were assisting people in a respectful and hygienic manner and two gentlemen in the dining room appeared Care Homes for Older People Page 18 of 33 Evidence: to be enjoying the social aspect of this time. As a result of a recent environmental health inspection the home was granted a very good rating in this area. This demonstrates that food is prepared in a hygienic manner. Care Homes for Older People Page 19 of 33 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. People are confident that concerns raised will be acted upon so that improvements can be made regarding their daily lives. There are systems in place that should protect people from harm. Evidence: We did not see the complaints procedure on display at the home, however an easy to read procedure about this was included within the statement of purpose. Despite this the majority of people living at the home and staff members told us in feedback from the surveys that they knew how to make a complaint. We looked at the complaints register held at the home and there were ten complaints recorded since our last visit. People had raised issues about the living environment, poor communication between the staff team and relatives, and the quality of food provided. There was evidence that each complaint had been taken seriously, had been investigated thoroughly and feedback had been given to the people making the complaint. Since our last visit there had been one allegation of an adult protection issue involving a person living at the home. The result of this was that the issue raised had been unfounded. We looked at the adult protection policy and spoke to staff about their understanding of the correct procedure to follow regarding such issues. Staff were Care Homes for Older People Page 20 of 33 Evidence: confident that they would take all measures to safeguard people living at the home and there was evidence that this had been the case regarding previous incidents. The majority of staff had recently undertaken training about the protection of vulnerable adults (POVA) and more training was planned. One staff member met during the visit said We have had POVA training and it is ongoing for new staff. I feel confident that I would raise any concerns. I would voice things as it is my responsibility. It was of concern that we were not informed during our visit that senior staff had received a telephone call from a social worker a week prior to our visit in order to discuss concerns raised by a visitor to the home about care practices. Details of this were not recorded in the complaints register. Care Homes for Older People Page 21 of 33 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 are provided with a clean comfortable and homely place to live which meets their assessed needs. Evidence: The home is a country house in extensive attractive grounds. A major extension and refurbishment of the home was completed last year. This means that the home is now able to provide accommodation for up to 40 people for nursing care and 20 of these people may also have dementia care needs. Care is provided in two separate units so that people with dementia are provided with safe living accommodation. There is a secure garden leading from the dementia care unit, and plans are in place to develop this area into a sensory garden. There is level access into the garden so that everyone can enjoy the facility. In addition there is an abundance of surrounding garden areas that are not secure for people to use if they choose to do so. There are fantastic views of the surrounding countryside and the Malvern Hills from a number of rooms within the home. The internal living environment is furnished and decorated to an excellent standard in a homely style that is in keeping with the age of the original building. One staff member who completed a survey prior to our visit said The home provides a comfortable and cheerful environment. Care Homes for Older People Page 22 of 33 Evidence: People living at the home have a choice of where to spend their time as there is a number of communal lounges dining rooms and other smaller and quieter seating areas throughout the home. People can spend their time in their own rooms if they choose to do so. Reminiscence pictures are on display in the dementia unit and plans are in place to introduce a memory lane concept. Appropriate music was being played in the lounge within the frail elderly unit, however a programme aimed at the pre school age group was showing on the large screen television in the dementia care unit. This was brought to the attention of the registered manager who promptly consulted with the people in the lounge about what they would like to watch and the channel was changed. There are a number of communal toilets and spacious bathrooms located throughout the home. There was a variety of assisted bathing and showering facilities that should meet the needs of people living at the home. These were found to be clean with the exception that a laundry bag full of dirty bed linen and clothing had been left opened on the floor of one of the communal bathrooms. Poor practice may result in the spread of infection at the home and is unnecessary as suitable equipment to transport bags to the laundry was available for the staff to use. This was brought to the registered managers attention and action was taken to remove the bag. We saw that the registered manager had undertaken an audit of the number of people living at the home who had developed sore skin either prior to or during their stay. There were currently four people living at the home who had sore skin. The registered manager stated that there was adequate and suitable pressure relieving equipment mattresses and cushions available at the home in order to meet these peoples needs. We were told that additional hoisting equipment had been purchased recently and the majority of beds were of a profiling type. This should promote the comfort of people who require assistance to move around on bed and those people who have to spend longer periods of time in bed. Bedrooms were spacious and had been personalised to reflect peoples interests. They contained items that are important to them for example photographs and ornaments. This should ensure that people feel comfortable and relaxed in their rooms. All bedrooms in the new extension have an en suite toilet facility and the five bedrooms in the original part of the building without an en suite facility have a toilet next to them. The temperature within the home was comfortable on the day of the visit, however we were told that radiators could not be manually adjusted without the maintenance person doing this. This means that people are not able to exercise control over the temperature within their rooms at the times that they want to. Care Homes for Older People Page 23 of 33 Evidence: We found that the home was clean and fresh and hygienic hand washing facilities were provided throughout. Feedback from the vast majority of surveys completed by people living at the home stated that the home was always clean and fresh. We were told however that there was not a machine provided to clean used commode pots located on the ground floor of the home. As a consequence of this the staff were manually cleaning the pots and this may result in cross infection. We saw evidence that a request for appropriate equipment for this had been made to the senior management team and actions were being taken in order to protect the well being of people living at the home and the staff team. The laundry is in the basement and is accessed down a set of steep and narrow stairs. Access to laundry is now on a keypad in order to prevent unauthorised access. There was an effective and hygienic laundry system in place for peoples bed linen and personal clothing. Care Homes for Older People Page 24 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home operates a robust system of recruiting staff for the protection of the people who live there. People are supported by the right number of staff who have the skills and knowledge to meet peoples needs in a safe manner. Evidence: The registered manager stated that staffing levels are based on the number and dependency of people living at the home. There are currently two registered nurses and eight care assistants on duty during the morning until early afternoon, and one registered nurse and six care assistants on duty until 9pm. There is one registered nurse and three care assistants on duty overnight. The staffing rotas identified that these levels were maintained for the majority of the time, and agency staff were used on a few occasions to cover periods of staff sickness and holidays. Feedback from the vast majority of surveys completed by people living at the home prior to the visit stated that the staff are available when they need them. Housekeeping administration kitchen and maintenance staff are employed so that people are supported in all aspects of their daily lives. The registered manager is on call to the person in charge of the shift so that they feel supported. The registered manager stated that staffing levels had been increased due to the opening of the dementia care unit. She stated that there had been a high staff Care Homes for Older People Page 25 of 33 Evidence: turnover of senior care staff however this had now stabilised and new senior staff had been recruited. She was confident that the skill mix of the team reflected the care needs of people living at the home. A registered mental health nurse had recently begun working at The Boynes. We had the opportunity to speak with her and she stated that she was enjoying sharing her knowledge of caring for people with dementia care needs with the rest of the staff team. This should ensure that staff gain further knowledge to provide a good standard of care in this area. The registered manager stated that the rural location of the home makes it difficult to recruit new staff. At the time of the visit there was a vacancy for a part time trained nurse and either agency or the homes staff cover this post at the current time. The vast majority of people living at the home are from a White British background however this is not reflected in the staff team. The vast majority of staff are from different cultural backgrounds and there have been concerns raised in the past about the competence of a number of staff members regarding their communication skills. We were told that a number of staff members were attending college to develop their knowledge of the English language. A number of staff met during the visit were from the Phillipines and Poland and communication skills varied however there was no evidence that peoples needs were not being met as a result of this. All staff met appeared to be enthusiastic and have a good knowledge of the needs of people living at the home. One staff member met during the visit said Staff moral is good and communication is improving. I do think staffing levels are adequate now and staff are happier. Staff meetings are held regularly so that they have the opportunity to put forward their views about the service provided. Two staff recruitment files were sampled and these contained all necessary information about the people prior to starting work at the home in order to safeguard people living at the home. New workers undertake a basic induction covering important health and safety issues for example fire safety and manual handling. Written records identified that new workers receive all of this information in one day therefore we would question the amount of time allocated to each topic. It was noted however that feedback from the vast majority of staff surveys stated that staff felt that the induction covered what they need to know. Following this staff undertake a comprehensive induction in line with the common induction standards in order to obtain the necessary skills and knowledge to provide a good standard of care. We looked at the training matrix for 2008 as the one for 2009 was not available on the day of the visit. Since our last visit the majority of staff had undertaken training about caring for people with dementia, care planning and customer care. Some staff had Care Homes for Older People Page 26 of 33 Evidence: received training about wound care and activity awareness. Forthcoming training included infection control and end of life care. The staff training matrix for 2008 identified that the majority of staff had received training about fire safety and a fire drill had been undertaken recently. Only half of the staff team had undertaken refresher training about manual handling and less than half had received training about food hygiene. During our visit we did not observe any poor practices in these areas, and following the visit the home told us that refresher training in these areas had already been provided in 2009. Eight members of staff have achieved a minimum of NVQ 2 in care and this is below the recommended 50 of the care staff team. We were told that a further seventeen staff members were currently working towards this. Care Homes for Older People Page 27 of 33 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. There are systems in place to protect and promote peoples health, safety and welfare. Evidence: The registered manager has been in post since December 2007 and has had previous experience of working within a care management role. She has undertaken recent training in order to update her skills and knowledge to lead the staff team. The registered manager stated that she has an open door policy so that anyone can come to speak to her when they wish. All staff met during the visit made positive comments about her management style. One person said The manager is fantastic. She is brilliant as a mentor. Feedback from staff surveys said Our manager is readily available to discuss problems and support with decisions. One person who lives at the home said My Wife and I both have easy access to the manager or senior nurse on duty. Care Homes for Older People Page 28 of 33 Evidence: Prior to the inspection, the registered manager had completed an Annual Quality Assurance Assessment AQAA and returned it to us. This gave us information about how the home think they are performing and any identified areas that require improving. It was noted however that as previously discussed we could not evidence that staff had undertaken all training as identified as being completed within the AQAA. There are systems in place to monitor the quality of service provided at The Boynes. This includes monitoring visits from a senior external manager. We sampled the comprehensive reports of these visits and it was evident that actions are taken to address any shortfalls identified for the benefit of the people living there. Service satisfaction questionnaires had been sent out to people living at the home and their families in August 2008, however the registered manager stated that the feedback reflected the major building work that was ongoing at that time. The registered manager stated that she will be sending out more surveys in early summer in order to obtain the views of the people using the service. Group meetings with people living at the home and their representatives are not arranged at the home and this may prevent people from putting forward their views about the service provided on a regular basis. The statement of purpose states that there is a system in place for the safekeeping of small amounts of money to be held on the behalf of people living at the home. The registered manager confirmed that no one currently uses this facility and people are invoiced for any money spent. Maintenance records were well maintained and safety checks were undertaken on equipment so that it should be safe to use. Whilst sampling care records we saw that one person living at the home had recently sustained significant bruising to the face and a cut on the forehead following a fall. We were told that the nursing staff had undertaken regular checks on this person and medical advice was not required on this occasion. Care Homes for Older People Page 29 of 33 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 30 of 33 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 7 13 Manual handling assessments must include up to date specific information Manual handling assessments must include up to date specific information 06/04/2009 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 1 The range of fees should be available to people so that they know how much they will have to pay if they want to live at the home. A system should be implemented so that prior to admission people get written confirmation that the home is suitable to meet their care needs. The system in place for summarised care plans should be reviewed so that they contain up to date information. Arrangements should be made so that peoples personal belongings are kept safe and private at all times. Activities on display should reflect the activities currently Page 31 of 33 2 4 3 4 5 7 10 12 Care Homes for Older People on offer so that people can choose which they want to join in with. 6 12 A review of activities should be undertaken in order to meet the needs interests abilities and expectations of all people living at the home. The complaints procedure should be on display so that people living at the home and their visitors know how to make a complaint, and a record of all complaints received should be kept. Arrangements should be made so that people living at the home, deemed to be safe to do so, can exercise control over the temperature of the radiator in their rooms so that the temperature within their rooms is of a comfortable level. Arrangements should be made so that at least 50 of the care staff have achieved NVQ level 2 so that they should have the necessary skills and knowledge to provide a good standard of care. Arrangements should be made so that people living at the home and those people important to them have the opportunity to meet together as a group to discuss the running of the home and put forward any suggestions for improvements. 7 16 8 25 9 28 10 32 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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. 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