CARE HOMES FOR OLDER PEOPLE
BUPA Care Homes West Ridings Lingwell Gate Lane Lofthouse Wakefield West Yorks WF3 3JX Lead Inspector
Tony Railton Unannounced Inspection 14th December 2005 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 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. BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service BUPA Care Homes Address West Ridings Lingwell Gate Lane Lofthouse Wakefield West Yorks WF3 3JX 01924 826806 01924 825743 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) Care First Care Homes Limited (BUPA Care Services) Miss Deborah Campey Care Home 180 Category(ies) of Dementia - over 65 years of age (45), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (30), Old age, not falling within any other category (150), Physical disability over 65 years of age (75) BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. 1 OP and PD under 65 years of age 1 MD and DE under 65 years of age Nidderdale, Swaledale, Wensleydale - 30 x DE(E), 30 x MD(E), 60 x OP and 60 x PD(E) Airedale - 5 x DE(E), 30 x OP and 5 x PD(E) Calderdale House - 5 x DE(E), 30 x OP and 5 x PD(E) personal care only Wharfedale House - 5 x DE(E), 30 x OP and 5 x PD(E) Date of last inspection 27th July 2005 Brief Description of the Service: BUPA West Ridings although under one registration is comprised of six thirty bed units and provides a total of 180 places for older people, some of whom may suffer from dementia, mental health problems, have a physical disability and or require nursing care. There is a manager for each of the six units who are directly supervised by the Registered Manager. Ground floor accommodation is offered to all service users and some of the bedrooms have patio doors leading to the gardens. Other bedrooms face inner courtyards which have garden furniture for the use of service users during the summer months. Each unit has communal areas including lounges, dining rooms and quiet lounges. All bedrooms are personalised and there are assisted bathing facilities for those who require them. Prospective service users are invited into the home to test drive the services offered and visitors are welcome. There is a reception area provided with administrators and the registered managers office. This building also houses the central kitchen, laundry and training rooms. The home is situated in Lofthouse on the outskirts of Wakefield, is on a main bus route and is close to Outwood train station. There are some local shops nearby including a post office, public houses and health centre. West Ridings is only a few minutes journey from the centre of Wakefield and all services and amenities and is also close to the M1/M62 link roads. BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a very positive and enjoyable unannounced inspection which commenced at 08.30 to give the inspectors the opportunity to observe the early morning routines on the units. The opportunity was also taken to speak to quite a few service users (56), relatives (2), care staff (7) and nursing staff (4), domestic supervisor (1), domestics (2) and of course the unit managers (5). The interaction between residents and care staff was observed as well as the administration of medicines. A number of service users records were examined and included assessments, risk assessments, care plans, reviews, medical and daily records. Staff, rotas and staff supervision notes were also examined. The inspector was pleased to note that there have been a number of improvements to the general physical environment on all units and to the care management systems. The registered manager said that there is still some work to do on certain units which are currently in a period of change which include changes to the management systems and staff deployment. The inspector was pleased to note that upon inspection there was no failure by the home to meet statutory requirements. It was also noted that the home also meets nearly all the minimum standards. The registered manager and her staff team are to be commended for their efforts in improving and maintaining such good standards throughout the home. What the service does well:
On the morning of the inspection the inspector was impressed with the positive attitude of the care staff, nursing staff, unit heads and registered manager towards service users and the work that they do. The interaction observed between staff and service users showed that there are positive relationships fostered. Nearly all service users spoken to said that they are happy living in the home and others said that the care staff are “very caring”, “wonderful”, and “very good”. One relative visiting someone who is very poorly said “oh the care has been second to none” he went on to say that “ all the staff are very helpful and kind”, and that they “do a good job”. Service users were observed having breakfast and been offered a choice of menu. Most service users said that the meals are “very good”, one female resident complained to the inspector that sometimes she had to wait for her
BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 6 breakfast, the inspector asked if breakfast was worth waiting for and she replied “Oh yes the food is very good you know”. It was noted that the views of service users and their relatives have been sought by way of quality assurance questionnaires. The comments made have been collated and a report published which reflects what service users and their relatives thought about the quality of care provided by the home. The findings were generally favourable. On the day of the inspection service users bedrooms were clean and free from unpleasant odours. Bedrooms were found to be homely and comfortable and most service users are surrounded by their own possessions. The communal areas appeared to be generally well maintained and decorated to a good standard, and service users appeared to be relaxed and comfortable. What has improved since the last inspection?
Everyone with the exception of one carer felt that the care and management systems in the home have improved. The unit managers in particular were pleased with the support they receive from the registered manager. There have been major improvements on the Calderdale Unit and in particular replacing the dining room and lounge carpets and decorating throughout. The manager has provided a programme of routine maintenance and renewal of the fabric and decoration of the premises. Another major and very important improvement is the reviewing of service users individual personal and health care plans. This has been a massive undertaking, however, the registered manager, unit managers, nurses and care staff are to be commended for their efforts in keeping service users care plans under regular review. The registered manager has undertaken a review of the dependency levels of service users on the Calderdale Unit and there have been modifications to the management and deployment of care staff. The manager said that there have been a number of changes which have improved the quality of care provided on this unit. Upon inspection service users appeared to be comfortable and relaxed. Care staff were observed carrying out their duties in a relaxed confident and competent manner. It was noted that West Ridings now has a quarterly ‘Homes Audit’ carried out by senior staff which includes reviewing the ordering, storage, administration and recording of medicines. The inspector welcomes this improvement to the management systems. The manager said that the audits should help in ensuring consistency in approach to the delivery of care on all the units. She
BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 7 also said that should help in maintaining and driving up care standards generally within the home. The quality assurance report showed that the views of service users and their relatives had been sought on the quality of care provided by the home. The information has been gathered together and a report published to reflect what service users and their family think about the home. The inspector was pleased to note that the survey had been carried out by an independent body. The registered manager informed the inspectors that 52 of care staff are now trained to NVQ Level 2 or above. Again, this has been a massive undertaking but nevertheless, this improvement demonstrates the homes commitment to staff training and improving the quality of care provided. What they could do better:
Although it was noted that service users care plans are now reviewed on a regular basis, the daily records show that they would benefit from more detail to reflect and show that ‘planned care’ has been given. The daily records would also benefit from descriptive words to reflect service users choices, preferences, likes and dislikes. The daily records need to provide evidence that service users still have some control over their lives and what they do on a day o day basis. Some service users risk assessments show that there is a risk identified, however, the assessment does not give any details about what action needs to be undertaken to minimise any risk to the services user or carer. Examination of staff supervision records show that generally most staff are receiving planned line management supervision. However, one units supervision records show that they have fallen behind and staff are not getting the amount of recommended supervision. The quality assurance report is good and shows that the views of service users and their families have been sought. However, there’s no evidence that anyone else, such as visiting healthcare professionals have been asked what they think of the home and the quality of care it provides. The quality assurance report has been carried out and produced independently which is commendable, however, it does not show what changes have been made to the way the home runs as a result of the surveys and the comments received. BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 8 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. BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 9 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 BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 10 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&6 No service user moves into the home without having their personal and healthcare needs assessed. EVIDENCE: Examination of some service users case files including assessments and through discussion with the manager it was established that all service users needs are assessed before they are admitted to the home. It was noted the quality and quantity of some service users assessments vary and in particular those admitted from hospital. However, the home has its own assessment process which commence before service users are admitted. West Ridings does not provide specialist services and facilities for intermediate care or rehabilitation. BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 11 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 & 10 Service users health, personal ad social care needs are set out in an individual plan of care. Service users are also assisted to make decisions about their lives with assistance as needed. EVIDENCE: Examination of some service users case files show that their personal and healthcare needs are assessed and care plans are implemented to meet them. It was noted that there have been improvements to the care planning systems in the home and that care plans are now reviewed on a regular basis. Examination of the daily records pertaining to some service users showed that their ‘planned care’ was not reflected in the daily records. Discussion with the registered manager showed that there is a need to reflect the actual care given on a day to day basis. Statements such as ‘cares given’ are not specific enough and do not give enough information. Observation of the medicine rounds show that there are adequate policies, procedures and practices for the safe ordering, storage administration and recording of service users medicines.
BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 12 Service users spoken to aid that the care staff are very good ad that they are treated with dignity and respect at all times. Observation of the interaction between staff and service users shows that there are positive relationships fostered between staff and service users. Staff were observed treating service users with dignity and also respecting their wishes. One relative said that the staff are “second to none” he also said that they are “very kind” and helpful”. The registered manager an her staff team are to be commended for ensuring that all service users care plans are reviewed on a regular basis. This is an improvement from the previous inspection. BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 13 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): 12,13,14 & 15 Service users find the lifestyle experienced in the home matches their expectations and satisfies their social, cultural and recreational interests. Service users are actively encouraged to maintain appropriate contact with family and friends. EVIDENCE: After speaking to over 50 service users throughout the morning of the inspection it was established that the majority of service users like living in the home. Most said that the staff are “very good” and that they are “well cared for”. Some service users are very able and could give a good account of life in the home. Most service users were observed making decisions about their daily lives and care staff were observed assisting some to make decisions and to make choices about their lives. The inspector was impressed with the positive attitude of care staff, nurses and unit managers towards service users. Examination of the daily records, however, do not show the decisions made by services users or reflect their daily choices and preferences.
BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 14 The diary of activities, activity posters on notice boards and daily records show that activities are organised on a regular basis for those who wish to participate. Some photographs displayed showed some service users and care staff enjoying the seasonal festivities together. Nearly all service users with one exception said that they enjoyed the meals provided. One service user complained that she has to wait sometimes for her meals. The inspector asked if the meals were worth waiting for and she replied “Oh yes the food is very good you know”. One male service user said that he enjoys a “cooked breakfast every morning without fail”. When asked he went on to say that he can “choose what he wants for breakfast”. BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 15 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): 16 & 18 Service users and their relatives can feel confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse and self harm. EVIDENCE: Discussion with service users their relatives and the registered manager and examination of the record of complaints showed that complaints are taken seriously, investigated and acted upon. The home continues to have a complaints policy and procedure which is easy to understand and accessible. It was noted that the home as a copy of the Wakefield Social Services and Health Multidisciplinary Adult Abuse and Protection Policy and Procedure. It was also noted that adult abuse forms part of the induction training for new staff. A recent allegation of abuse was discussed with the registered manager who said that all allegations are taken very seriously and are thoroughly investigated. The manager went on to say that abuse in any form will not be tolerated and disciplinary action will be taken if any allegations are substantiated. The regulation 37 reportable incident forms show that the home continues to comply with statutory requirements.
BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 16 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, 24 & 26 Service users live in a well decorated and well maintained home which is safe and comfortable. Service users have rooms of their own which are homely and comfortable and most are surrounded by their own possessions. EVIDENCE: Inspection of the units including lounges, dining rooms and bedrooms show that residents live in a safe and well maintained home. It was noted that there have been major improvements on the Calderdale and Wensleydale these major improvements to the environment are to be commended. Discussion with service users, care staff, nurses and relatives show that generally service users are happy with their own bedrooms which are personalised and homely. One service user said that she “liked” her room another said that he has “everything he needs”. One service users relative said that his elatives bedroom is “very nice”, and “its home from home really”. BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 17 The inspector was impressed with the new furniture and in particular the new floor coverings in a number of bedrooms on Wensleydale which look very good are serviceable, practical and at the same time are homely and comfortable. The owners of the home are to be commended for the improvements to the home and for their investment. Standards to the environment have been improved and the quality of life of service users raised. BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 18 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 & 30 Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands and are protected by the homes staff selection and recruitment policies and practices. EVIDENCE: Examination of staff personal files and training records, and through discussion with the registered manager and unit managers it was established that service users personal and healthcare needs are met by appropriately trained staff. It was also noted that staff appeared to be available in sufficient numbers to carry out their duties in a relaxed and unhurried manner. One service user said that the “staff are wonderful”, another that “staff are very caring and helpful”. One service users relative said that the “staff are second to none” and that they are “very caring and thoughtful” The registered manager said that 52 of care staff now have National Vocational Qualification at level 2 or above. This improvement is to be commended. Staff files show that appropriate checks, such as CRB and Protection of Vulnerable Adult List are carried out on prospective candidates before they are employed. Service users continue to be safeguarded and protected by the homes staff selection and recruitment process. BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 33, 35 & 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 is able to discharge her responsibilities fully. Service users benefit from the way the home is run and their best interests are safeguarded. EVIDENCE: There have been improvements to the care management systems with the home since the last inspection and in particular, care plan reviewing and staff training. The home has monthly audits carried out by senior staff and a report is provided to highlight areas for improvement. There have been improvements to the management and staff deployment in the individual units which has made a difference to the way care is provided. Discussion with the registered manager indicates that one unit is currently in a period of change.
BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 20 The inspectors noted that there was a ‘difference’ in the atmosphere on this unit. The manager gave assurances that the planned changes will benefit service users and staff and will become effective in the new year. The quality assurance report showed that an independent survey has been undertaken to find out what service users and their relatives think about the quality of care provided by the home. The report reflects service users views however, it does not indicate what changes have been made to the home or action taken as a result of what service users or their relatives said. To comply fully with minimum standards the registered manager said that the views of other stakeholders such as visiting healthcare professionals should also be sought. The staff supervision notes showed that some staff have had six line management supervision sessions this year. However, some records show that some units have fallen behind and that staff are not receiving the amount of supervision recommended by minimum standards. Service users case files including financial records indicate that services users rights and best interests are safeguarded and protected by the financial policies, procedures and practices. Staff training records including first aid, moving and handling and basic food hygiene show that the health and safety of service users and staff id promoted and protected by the homes policies and practices. On the day of the inspection staff were observed wearing and using the appropriate equipment and clothing to protect themselves and service users. BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 X 3 BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement On the day of the inspection there was no failure to meet statutory requirements noted. Timescale for action 14/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP7 OP8 OP12 OP14 OP33 Good Practice Recommendations The daily records should have more detail added to reflect and show what planned care has been given. Decisions made by service users should be reflected in the daily records to show that they have some control over their own lives. Descriptive words should be used in the daily records to reflect residents choices and preferences with regard to activities undertaken. The home should use descriptive words in the daily records to demonstrate that service users have autonomy and choice. The views of other stakeholders such as visiting healthcare professionals should also be sought regarding the quality of care provided by the home. BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 23 6. OP36 All care staff should receive a minimum of six line management supervision sessions per year. BUPA Care Homes DS0000006304.V265669.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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