CARE HOMES FOR OLDER PEOPLE
BUPA Care Homes West Ridings Lingwell Gate Lane Lofthouse Wakefield West Yorks WF3 3JX Lead Inspector
Tony Railton Key Unannounced Inspection 24th January 2007 08:00 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.V326261.R01.S.doc Version 5.2 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.V326261.R01.S.doc Version 5.2 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) www.bupa.com BUPA Care Homes (CFHCare) Limited Miss Deborah Campey Care Home 180 Category(ies) of Dementia - over 65 years of age (150), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (150), Old age, not falling within any other category (150), Physical disability over 65 years of age (150) BUPA Care Homes DS0000006304.V326261.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th December 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. On the 16th November 2007 the providers said that range of fees for living in the home is between £349.00 and £439.50 and that there are extra charges for hairdressing (between £5.00 and £20.00) and for newspapers and Chiropody (£7.00). Further information can be obtained by contacting the home or visiting www.bupa.com BUPA Care Homes DS0000006304.V326261.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection visit to West Ridings commenced at 08.00 and ended at 14.00 and was carried out by two CSCI Regulation Inspectors. This was a very positive visit to the home and a number of improvements were noted. During the visit there was the opportunity to talk to some service users, some of their relatives, some nurses, care staff and the unit managers. Information gathered before the visit was also considered and included service users and relative’s surveys, the pre inspection questionnaire and service history. Some service users and staff records were seen and a tour of the houses undertaken. Other records including the record of complaints were seen and three complaints in particular were discussed with the new acting manager. It was noted that the service continues to meet all statutory requirements and almost all minimum standards. The opportunity must be taken to thank the acting manager, all the service users, the senior staff in charge of the houses and their staff teams for their hospitality and their co-operation throughout the visit to the service. What the service does well:
The assessment of needs and in particular nursing needs is good. Service users have moving and handling and nutritional risk assessments. Care plans are detailed and are reviewed on a regular basis. Service users spoken to say that they enjoy living in the home. One service user said that the staff are “really good” and “look after him really well”. One relative said “the staff are wonderful and caring”. One service user said that she liked sitting and talking to her friends and that it’s like “home from home”. Throughout the visit positive relationships were observed between service users and care staff. One junior sister said that her staff are “very good and committed to their work”. Another service user said that he likes having a game of Bingo and that he enjoys playing Dominoes with his friends. Another said that the meals are good and that she has a choice of what she wants to eat. Service users were observed having breakfast in relaxed and comfortable surroundings and staff were available in sufficient numbers to carry out their duties in a relaxed and unhurried manner. BUPA Care Homes DS0000006304.V326261.R01.S.doc Version 5.2 Page 6 One of the residential units,(Airedale), after been nominated by service users and their relatives, won a BUPA Award for the quality of care it provides. The manager said that activities and social events take place on a regular basis and relatives are fully involved in supporting the home. What has improved since the last inspection? What they could do better:
Despite the improvements to the daily records, descriptive words should be used more often to reflect and show service users choices and preferences. Some service users are very able and make decisions about how they live their lives on a daily basis. Descriptive words in the daily records would reflect this. The quality assurance systems have improved and an independent survey is carried out annually to see what service users think of the quality of care provided by the home. However, the views of visitors, relatives and healthcare professionals and social workers should also be sought regarding the quality of care provided. The manager said that she is currently arranging Protection of Vulnerable Adults Training with the local authority and plans to have this delivered to all staff during 2007. BUPA Care Homes DS0000006304.V326261.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. BUPA Care Homes DS0000006304.V326261.R01.S.doc Version 5.2 Page 8 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.V326261.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards looked at are 3 and 6. Service users have an assessment of their personal and healthcare needs before they are admitted to the home. The home does not provide specialist facilities for intermediate care or rehabilitation Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of twelve service users records found that an assessment of their personal and healthcare needs is undertaken before they are admitted. Some showed assessments carried out by the Health Authority and others by Social Workers. A designated trained nurse assesses Service users living in their own homes, before they are admitted. Discussion with the new acting manager confirmed that the home does not provide specialist service for intermediate care or rehabilitation. BUPA Care Homes DS0000006304.V326261.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards looked at are 7,8, 9 and 10. Service users personal and healthcare needs are set out in their individual plan of care and there health care needs are met. Service users are safeguarded and protected by the medicine administration systems within the home. Service users said that they are treated with respect and their right to privacy upheld. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Twelve service users records showed that their personal and healthcare needs are assessed and that care is planned and reviewed. The medical records show and include visits by general practitioners, district nurses, and continence advisors. Records also show visits to service users by the optician and chiropodist. There was also evidence of planned admissions to hospital and appointments at various clinics. Staff records show that the medicines in the home are only administered by qualified nurses or by senior staff who have received training. A sample of six service users medicines were examined and found to be administered correctly. The returned CSCI service users and relative’s questionnaires show that they are happy with the care provided and that they are treated with dignity and
BUPA Care Homes DS0000006304.V326261.R01.S.doc Version 5.2 Page 11 their wishes are respected. Discussion with service users found that they are happy with the care provided. Staff were observed fostering good positive relationships with service users throughout the visit. The daily records would benefit from the use of descriptive words to reflect service users choices and preferences, likes and dislikes. BUPA Care Homes DS0000006304.V326261.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards looked at are 12,13,14 and 15.Service users find the lifestyle experienced in the home matches their expectations. Positive relationship’s with family and friends is encouraged. Service users are assisted to exercise choice and control over their lives. Service users are offered a wholesome diet in pleasing surroundings. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two relatives visiting Nidderdale House said that they visit the home on a regular basis and have always been made to feel welcome. The returned CSCI service user surveys show that there are no concerns about the meals provided. One service user said that the meals are “very good” and that he gets “plenty to eat”. Breakfast was observed on Whafdale House and service users enjoyed their breakfast in relaxed and pleasant surroundings. Staff were observed giving service users a choice of menu, which included a cooked breakfast if they so wished. The acting manager said that there are three activities coordinators who arrange activities on all six houses. The record of activities in service users case files show that they are offered a range of activities throughout the week. The daily records, however, would benefit from the use of descriptive words to reflect and show service users choices and preferences. BUPA Care Homes DS0000006304.V326261.R01.S.doc Version 5.2 Page 13 The unit manager on Airdale House said that the unit had recently (19th October 2006) been awarded a BUPA ‘One Life Ambassador’ certificate after been nominated by service users and their relatives. The certificate displayed reflects the activities and social events enjoyed by service users and their families. The unit manager said that relatives are encouraged to participate and comment on the quality of care provided by the home and participate in activities and fund raising events. BUPA Care Homes DS0000006304.V326261.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards looked at are 16 and 18. Service users and their relatives know that their complaints will be listened to and acted upon. Service users are protected from abuse by the homes adult abuse and protection policies and procedures. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The returned CSCI service users and relatives surveys show that they know how to make a complaint. The service history shows that there have been three complaints made to the CSCI over the past twelve months. The outcome of these complaints was discussed with the acting manager as well as one Adult Protection referral. The record of complaints show that they were appropriately dealt with. Staff training records show that adult abuse forms part of induction and that some have received POVA training. However it was noted some staff have not had any formal Protection of Vulnerable adults training. The acting manager said that she is currently arranging POVA training for all her staff with Wakefield local authority and Primary Healthcare Trust. She anticipates all staff having this training in the coming year. BUPA Care Homes DS0000006304.V326261.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards looked at are 19 and 26. Service users live in a safe and wellmaintained and clean environment. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A visit to all six houses found them to be well decorated and well maintained. The pre inspection questionnaire shows a number of improvements to the home since the last visit. These include 15 redecorated bedrooms on Nidderdale House, a new shower fitted to Swaledale and Calderdale Houses. Other general improvements were noted including the provision of memory boxes for each service users bedroom, decorated corridors on all units and four redecorated and themed lounges. New fencing was noted around the Calderdale unit. Throughout the visit all areas of the houses appeared to be clean and were free from any unpleasant odours. BUPA Care Homes DS0000006304.V326261.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards looked at are 27,28.29 and 30. The numbers and skill mix of staff meets Service users needs. Service users are protected and safeguarded by the staff selection and recruitment policies and practices. Staff are trained and competent to there jobs. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the visit there appeared to be enough staff on duty to meet the needs of service users in a relaxed and unhurried manner. The pre inspection questionnaire shows and 70 of care staff have a National Vocational Qualification Level or above. A sample of Staff training records and the pre inspection questionnaire also show that other training has been provided in 2006 and included, Continence Care, Wound Care Awareness, First Aid, Food Hygiene, Dementia Awareness, Medication training, Infection control, and some Adult Abuse Training. Other training included Behavioural (BASOLL) Assessment, Managing Challenging behaviour, Communication and Pain Management. The acting manager stated that formal Adult Abuse training provided y the local authority is planned for all staff to attend in the coming year. It was noted that two of the returned CSCI service users and one relative’s surveys said that sometimes there was not enough staff on duty. Discussion with the house managers, nursing and care staff showed that they feel the staffing levels have got better. It was noted that the new acting manager has introduced an information sheet, which is completed each morning and identifies any staffing issues. One
BUPA Care Homes DS0000006304.V326261.R01.S.doc Version 5.2 Page 17 senior nurse said that things have improved, however, some staff moves are inevitable to cover things like sickness but that these are only occasional. BUPA Care Homes DS0000006304.V326261.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards looked at are 31,33,35 and 38. Service users benefit from living in a well run home. The home is run in the best interests of service users and were the safety and welfare of service users and staff are promoted and protected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The new acting manager is a Registered General Nurse and has nearly completed the Registered Managers award NVQ Level 4, she also has a management qualification and has previously been registered with the Commission for Social Care Inspection. She has many years of management experience both in the public and private sector and has previously managed a large BUPA care home for the elderly. Staff supervision records show that all staff are provided with regular line management supervision, which is recorded. BUPA Care Homes DS0000006304.V326261.R01.S.doc Version 5.2 Page 19 The BUPA Care Home Resident Satisfaction Survey Report for 2005 shows that an independent consultancy is used to seek the views of service users and provide a report on the quality of care provided. The acting manager said that last years report is not available yet. It was noted that the views of other visiting healthcare professionals including General Practitioners, District Nurses, Continence Advisors, Social Workers and Reviewing officers about the quality of care provided by the home was not sought. BUPA Care Homes DS0000006304.V326261.R01.S.doc Version 5.2 Page 20 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 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 x X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 BUPA Care Homes DS0000006304.V326261.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? N/A 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 Timescale for action 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 Refer to Standard OP7 OP8 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. 3. OP12 4. OP14 BUPA Care Homes DS0000006304.V326261.R01.S.doc Version 5.2 Page 22 5 6 OP30 OP33 All care staff should receive Protection of Vulnerable Adults update training. The views of other stakeholders such as visiting healthcare professionals should also be sought regarding the quality of care provided by the home. And their views form part of the quality assurance report. BUPA Care Homes DS0000006304.V326261.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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