Inspection on 27/03/06 for Boynes Nursing Home, The

This inspection was carried out on 27th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Boynes Nursing Home, The 02/03/09

Boynes Nursing Home, The 10/12/07

Boynes Nursing Home, The 21/08/06

Boynes Nursing Home, The 23/06/05

Boynes Nursing Home, The 14/03/05

Boynes Nursing Home, The 20/09/04

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Boynes Nursing Home, The Upper Hook Road Upton-upon-severn Worcestershire WR8 0SB Lead Inspector N Richards Unannounced Inspection 27th March 2006 10:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Boynes Nursing Home, The Address Upper Hook Road Upton-upon-severn Worcestershire WR8 0SB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01684 594001 01684 594855 St Cloud Care Plc Miss Joanna Kate Baines Care Home 28 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (28), of places Physical disability over 65 years of age (28), Terminally ill (3) Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home may accommodate one named service user under 65 years with a learning disability. 23rd June 2005 Date of last inspection Brief Description of the Service: The Boynes Nursing Home is a country house in a rural setting, with views of the Malvern Hills and surrounding countryside. The home is part of St Cloud Care Plc and is registered to provide nursing care for a maximum of twenty eight people aged 65 years and over. As part of the registration the home can accommodate three people with a terminal illness and three people with a dementia related illness. The home has a total of 22 single bedrooms, 14 of which have en-suite facilities, and 3 shared bedrooms. First floor bedrooms can be accessed by a passenger lift . Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over a period of 2½ hours. The last inspection at The Boynes took place during June 2005. The Inspection started at 10.45hrs. On the day of the inspection there were 23 residents at the home. The main focus of this inspection was to review requirements from the previous inspection. A tour of the home took place and a selection of staffing, care, personnel and health and safety records were examined. Staff and residents were spoken to during the visit, in order to ascertain their views on living and working at The Boynes. What the service does well: What has improved since the last inspection? What they could do better: Care plans require developing, and risk assessments must generate effective plans of care when a risk is identified. Staffing levels must be reviewed, and an appropriate manager for the home must be appointed to help consolidate work necessary for compliance with National Minimum Standards. Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Residents’ individual needs are assessed prior to them moving into the home in order to establish the home’s ability to meet those needs and appropriate care to be provided. EVIDENCE: All residents are assessed prior to their admission to the home to establish their individual needs and to determine if those needs could be met by the home. Residents spoken to stated that the home was meeting their needs appropriately and they were pleased with the service provision. The home does not contract to provide intermediate care. Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Some progress has been made on improving arrangements to ensure that the health care needs of residents are identified and met. These improvements help to safeguard the health care needs of residents. However, on occasions the medication at the home is not well managed, which potentially places residents at risk. Care plans were insufficient, and failed to provide staff with information regarding residents’ care needs. Risks identified through assessment needed to generate robust plans of care. EVIDENCE: Care plans for four residents were reviewed during the inspection. Individual plans of care are available, but limited progress has been made to ensure that aspects of health, personal and social care needs are identified and suitably planned for. Plans examined were not sufficiently detailed; they were not up to date and had not been regularly reviewed. There exists significant room for Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 10 improvement in relation to ensuring that care plans effectively and clearly provide instruction and guidance to care staff in a manner that is easily understandable. Since the time of the previous inspection, care documentation relating to people who are diabetic has deteriorated significantly, and fails to demonstrate evidence and research-based practice. Records failed to demonstrate collaborative work practice with external health care specialists such as the local diabetic liaison nurse. Residents spoken to were happy to confirm that care needs were being met by staff within the home in a dignified and respectful way. Staff were seen providing care sensitively and discretely to residents, and discussions with staff confirmed that they were aware of residents’ care needs, and how the care was to be provided. Nursing staff were observed administering medication to residents. Medication was administered safely and sensitively to ensure that the right medication was administered to the right person, at the right time and in the right dose – thereby promoting the safety and well being of residents. The standard of recording the medication administered to residents has improved since the time of the last inspection, and Medication Administration Record (MAR) charts had, generally, been carefully completed. However, some MAR charts had not been completed by nurses with the same level of care and attention i.e. sometimes nurses had not signed MAR charts when medication had been administered, and some medication prescribed on a variable dose basis did not have the actual dose administered recorded. There were, on occasions, times when MAR charts had been manually altered without any corresponding signatures from the nurse/s responsible for altering the MAR chart. These omissions have the possibility of placing residents at risk. Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 15 Meals are well managed, creative and provide daily variety and flexibility for people living in the home. Contact with family and friends was openly maintained. EVIDENCE: A number of people living in the home were spoken to and everyone who commented on the food said how good it was, and how they welcomed the daily choices offered. Menus were balanced, and mealtime arrangements are also flexible enough to accommodate individual preferences. Catering staff demonstrated a good knowledge and understanding of individual residents’ dietary preferences and requirements. The kitchen is staffed between the hours of 7am and 2.30 pm and between the hours of 4pm and 6.30pm each day. Outside of these hours, care staff are available to provide drinks and snacks to residents if required, and as necessary. Food and drink was available throughout the twenty-four hour period, and standards relating to meals and mealtimes have improved since the time of the previous inspection. During the inspection, some relatives were seen visiting people, and staff greeted visitors politely. Residents spoken to said that they could receive visitors at any time of the day, thereby maintaining links with family members. Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not examined at the time of the inspection. EVIDENCE: These standards were not examined at the time of the inspection. Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 There have been some improvements to the décor and furnishings within the last 18 months and this does help to partly create a comfortable and safe environment to live in. However, some areas within the home have not benefited from redecoration, and this has a poor impact on the environment. EVIDENCE: Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 14 Many bedrooms seen had been furnished with residents’ personal possessions, thereby generating ownership and a sense of autonomy for individuals, and several residents confirmed that they appreciated the physical environment. However, there were some areas within the home where bedrooms could be further enhanced through redecoration and the provision of better quality furnishings – which were, in several bedrooms, looking worn. Not all bedrooms possessed lockable storage space for individual resident’s medication, money and valuables. It is understood that the furniture within the home is being reviewed and will be replaced as necessary. It was noted that the home was soon to have replacement floor coverings fitted. Bedroom doors possessed devices that allowed them to be held open automatically, but would close them should the fire alarm sound. However, doors did not possess single-action locking devices. Staff stated that this would probably be addressed during the course of the planned extension and refurbishment/upgrade, along with the necessary environmental upgrades. At the time of inspection, the home was visually clean, tidy and free from offensive odours. It was noted that several residents had bed side-rails positioned on their beds to prevent them from accidentally falling of their beds and sustaining an injury. However, given the reported incidences of entrapment documented by the (former) Medical Devices Agency (MDA), care records were examined, and failed to contain risk assessments for the fitting of bed side-rails. Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Staffing levels and working practice during the daytime period require reviewing to ensure that staffing is provided in sufficient numbers to effectively meet the needs of residents in a timely manner. EVIDENCE: At the time of inspection, one registered nurse and five carers, who were providing care to 23 residents, staffed the home. The nurse was administering medication to residents at 10.45hrs. – after administering direct care to some residents. When interviewed, the nurse believed that the staffing levels within the home were not sufficient to meet the needs of residents in a timely manner. It is conceded that, since the time of the previous inspection, staffing levels at night have been increased to one registered nurse and two carers, but a review of daytime staffing levels and work practices is necessary to ensure that the home is staffed in suitable numbers to enable care to be delivered to residents in a timely and responsive manner. Staff expressed the viewpoint that, due to the home’s staffing levels, record keeping is and has been compromised due to the prioritisation of care delivery resulting from insufficient staffing levels. Many residents within the home were assessed as being “high dependency”. In addition to nursing and care staff, there were also ancillary staff on duty to support service provision. Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 16 The duty rotas confirmed that the staffing levels were stable, with little evidence of staff being absent through short-term sickness. Training is in the process of being provided to staff in response to residents’ assessed needs, and a qualified first-aider was on duty throughout the 24-hour period. The duty rota did not, however, identify the first-aider on duty. Four staff files were examined and each file contained the necessary documents required to confirm that a robust recruitment and selection procedure was adopted and implemented within the home. All four files contained a completed application form, two written references, a completed CRB (Criminal Records Bureau) check, a contract of employment and proof of identity along with copy certificates. Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 37 and 38 Since the very recent departure of the home’s manager (and in the absence of a registered manager), there is no clear leadership, guidance and direction to staff to ensure residents receive consistent care, resulting in practices that promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: The home’s manager-designate had recently terminated her employment within the home, and the responsible individual was attempting to appoint interim (temporary) managerial cover to ensure that the home is effectively managed until a permanent manager can be appointed to post. The quality of care provided in a care home is strongly influenced by the calibre of the registered manager and their relationship with the registered provider Therefore, it is vitally important to ensure that a suitable individual is recruited and appointed as the care home manager. Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 18 Quality assurance (QA) forms were made available at the time of inspection. These were dated “2004”, but staff did express the view that new QA forms were due to be distributed to residents, and their findings analysed and actioned. Residents clearly expressed their opinion that the home was being run in their best interests. Records were available that confirmed that health and safety arrangements were suitable in ensuring that residents’ (and staff’s) safety was promoted and protected as far as is reasonable to expect within any work (or living) environment. Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 3 3 3 2 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X X X 3 3 Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 15(1) Timescale for action Care plans must accurately detail 27/03/06 the specific care, including aids and equipment, to be provided to meet the individual needs of residents. Previous requirements of 20/09/04, 14/03/05 and 23/06/05 not met. Care plans must be in place for 27/03/06 each resident where emotional and psychological needs have been identified through assessment. Care plans must accurately detail the care and support required. Previous requirements of 20/09/04, 14/03/05 and 23/06/05 not met. Resident involvement within the 27/03/06 care planning process must be promoted and documented. Previous requirements of 14/03/05 and 23/06/05 not met. Care plans for residents with 27/03/06 diabetes must include details of their normal (targeted) blood glucose range, and accurate information regarding the DS0000004097.V265776.R01.S.doc Version 5.1 Page 21 Requirement 2 OP7 15(1) 3 OP7 15(2) 4 OP7 12(1), 15(1) Boynes Nursing Home, The 5 OP8 12(1), 13(4) 6 OP8 12(1), 15(1) 7 OP7 12(1), 15(1) 8 OP9 13(2) 9 OP9 13(2) 10 OP22 13(4), 17(1), Schedule 3 frequency in which blood glucose levels are to be monitored must be documented. Information must also be detailed in relation to the action staff must take if symptoms of hypoglycaemia or hyperglycaemia become apparent. Previous requirement of 23/06/05 not met. Residents identified as being at high nutritional risk must be monitored and supported, with specialist intervention accessed as necessary. This must be documented. Previous requirement of 23/06/05 not met. Care records must accurately evidence and demonstrate the care being given to residents with high dependency needs. Previous requirement of 23/06/05 not met. Care plans must be reviewed and updated at least once a month (more frequently when any significant changes occur). Previous requirement of 23/06/05 not met. Any written additions or amendments to the MAR charts must be checked, dated and counter-signed by two registered nurses. Previous requirement of 23/06/05 not met. Registered nurses must sign for all medication administered, or document a recognised code explaining the reason for any omissions. Previous requirement of 23/06/05 not met. Bed side-rails must only be fitted following a written assessment, which must detail the suitability of use and the management of DS0000004097.V265776.R01.S.doc 27/03/06 27/03/06 27/03/06 27/03/06 27/03/06 27/03/06 Boynes Nursing Home, The Version 5.1 Page 22 11 OP24 12, 13 12 OP27 18(1) 13 OP31 8(1)(a) risks. Written consent must always be obtained by the resident or their representative. Previous requirement of 23/06/5 not met. The doors of residents’ bedrooms 31/03/07 must be fitted with a lock suited to each resident’s capabilities, and must be accessible to staff in emergencies. Previous requirements of 20/09/04, 14/03/05 and 23/06/05 not met. Staffing levels and practices 30/06/06 during the daytime period must be reviewed to ensure the home is staffed in sufficient numbers to meet the assessed needs of residents within the home. A manager must be appointed to 30/06/06 the home, and an application for registration by the Commission must be completed and submitted to the local office of the CSCI. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Boynes Nursing Home, The DS0000004097.V265776.R01.S.doc Version 5.1 Page 24 - 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. 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