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Inspection on 23/01/06 for BUPA Highclere Nursing Home

Also see our care home review for BUPA Highclere Nursing Home for more information

This inspection was carried out on 23rd January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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.

What the care home does well

The home provides a very pleasant and comfortable environment in which service users can live. Individuals are encouraged to personalise their own rooms with their own furniture and personal belongings. Meals are of a high standard and always presented in an appealing way. Medication is well managed in the home with relevant procedures in place for the administration of medicines. There is a motivated and established staff team that consists of nursing and care/support staff. There is an effective complaints procedure with all complaints and concerns being acted upon promptly, within stated time scales. There is good support for the home by the provider organisation, with effective monitoring and quality assurance systems in place. There is an extensive range of policies and procedures, providing care staff with relevant information about all aspects of care and the home/organisation. The health and safety policies and procedures are clear and informative and care staff receive the relevant training to make certain safe working practices are maintained. All records for health and safety matters are accurate, up to date and well maintained.

What has improved since the last inspection?

The environment is constantly being improved with prompt attention to repairs and a rolling programme of maintenance and decoration. The home have managed to maintain a good standard of care ensuring the personal, emotional and health care needs for service users continue to be met.

What the care home could do better:

The home is to be commended on the high standards observed during the inspection. They need to maintain these standards to ensure service users continue to receive a high standard of care.

CARE HOMES FOR OLDER PEOPLE BUPA Highclere Nursing Home Chapman Avenue Downs Barn Milton Keynes Buckinghamshire MK14 7NH Lead Inspector Barbara Mulligan Unannounced Inspection 09:50 23 January 2006 rd 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 Highclere Nursing Home DS0000019228.V271888.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 Highclere Nursing Home DS0000019228.V271888.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service BUPA Highclere Nursing Home Address Chapman Avenue Downs Barn Milton Keynes Buckinghamshire MK14 7NH 01908 667568 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) finlaysj@bupa.com BUPA Care Homes (BNH) Limited No. 2079932 Ms Catherine Jane Finlayson Care Home 41 Category(ies) of Dementia (12), Old age, not falling within any registration, with number other category (41) of places BUPA Highclere Nursing Home DS0000019228.V271888.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Physical Illness ( Respite ) 40 years plus Date of last inspection 23rd June 2005 Brief Description of the Service: BUPA Highclere Nursing Home is a two storey, purpose built Nursing Home owned by BUPA Care, and especially designed for older people, with easy access for wheelchairs. Access to the upper floor is via a service lift. BUPA Highclere offers long term care for older people who need daily nursing or respite care to enable carers to take a break, or convalescent or post-operative care for older people recovering from an accident, illness or operation. It is situated in a residential area of Milton Keynes, and is within a short distance of local shops, church and public house. The centre of Milton Keynes is close by offering a large shopping centre, cinema, a range of restaurants and recreational activities. Public transport is accessible to service users living in their home. BUPA Highclere Nursing Home offers all single room accommodation but is able to cater for couples, and they have accommodated this in the past. Twenty-two rooms offer en-suite facilities, and those that dont, have toilet and bathing facilities close by. The home has several, tastefully decorated lounges and a light and spacious dining room, which overlooks the garden. There is an activities room where hairdressing, card games and other social activities take place. BUPA Highclere is set within its own gardens that offer peaceful and secluded surroundings. BUPA Highclere Nursing Home DS0000019228.V271888.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 23rd January 2006 at 09.50am. The visit consisted of discussions with the registered manager and records, policies and procedures were examined. The inspection officer was Barbara Mulligan. The Registered Manager of the home is Jane Finlayson. What the service does well: What has improved since the last inspection? What they could do better: BUPA Highclere Nursing Home DS0000019228.V271888.R01.S.doc Version 5.0 Page 6 The home is to be commended on the high standards observed during the inspection. They need to maintain these standards to ensure service users continue to receive a high standard of care. 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 Highclere Nursing Home DS0000019228.V271888.R01.S.doc Version 5.0 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 BUPA Highclere Nursing Home DS0000019228.V271888.R01.S.doc Version 5.0 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): 1, 2, 3, 4, 5 and 6 The homes Statement of Purpose and Service Users Guide provide service users and prospective service users with details of the services the home provides. However, these need to be updated due to recent changes. Each service user has an individual written statement of terms and conditions that is signed by service users or relative or relevant third party and the registered manager. Service users needs are thoroughly assessed prior to admission ensuring that staff are prepared for admission and have a clear understanding of the service users requirements. Service users receive care services from staff who have the skills and competencies to meet their care needs. Prospective service users have the opportunity to visit the home on an introductory basis, before making a decision to move there, ensuring that service users are able to make an informed choice about where they live. BUPA Highclere Nursing Home DS0000019228.V271888.R01.S.doc Version 5.0 Page 9 EVIDENCE: The Statement of Purpose and Service Users Guide contain all the necessary information as detailed in Schedule 1and Regulation 5. However, there is a new Deputy Manager, Operational Manager and the Registered Manager is due to leave within the next five days and changes need to be made to both documents. The inspector requests a copy of both documents when they have been updated. All service users are given a contract that details the terms and conditions of occupancy. It is the responsibility of the manager to carry out the initial assessment of need. The manager stated that she will visit a potential service user either in the hospital or occasionally in their home to undertake the initial assessment of needs. On some occasions potential service users are invited into the home for the day where the initial assessment can take place. The home uses an assessment tool devised by the manager and this covers, present medical history, past medical history, medication, mobility, allergies, pressure area care, nutritional status, personal hygiene needs, continence needs, mental health, and a section for any other significant information. Potential service users are then invited to visit the home. This procedure is used for individuals referred through care management arrangements and for individuals who are self funding. There is evidence from care notes that care-plans are working documents. The environment is designed to meet the requirements of service users who have physical needs and specialist equipment was observed around the home. The home employs ten registered nurses who are able to meet the health needs of service users. Prospective service users are invited to spend time at BUPA Highclere. The length and type of visit is individual to each potential service user, and may consist of an afternoon visit, a day visit or a weekend visit. If the visit is successful then an admission is planned. It is at this time that a key-worker is allocated. The potential service user has a review after the first four weeks to assess their stay in the home. Service users are not admitted for intermediate care. . BUPA Highclere Nursing Home DS0000019228.V271888.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 11 Clear and consistent care planning systems are in place that provides staff with adequate information they need to satisfactorily meet service users needs. The health care needs of service users are well met with evidence of good multi disciplinary working taking place on a regular basis. There are good policies/procedures in place to ensure that the ageing, illness and death of a service user will be handled with respect and as the individual would wish. EVIDENCE: The service users initial assessment is used to draw up the service users plan of care. At the time of the inspection this is the responsibility of the registered nurses, with involvement from the service user, family and care staff. This forms the basis of care to be delivered. A random selection of care plans were examined by the inspector and they showed that a variety of health care needs, personal and social care needs have been identified and a detailed action/nursing plan put in place to meet those needs. BUPA Highclere Nursing Home DS0000019228.V271888.R01.S.doc Version 5.0 Page 11 All care plans are informative and comprehensive. Risk assessments are in place regarding moving and handling needs, the prevention of falls, the use of bed rails, pressure area care and nutritional risk assessments. There was evidence to show that changes to care plans where made to reflect the changing needs of service users. There is evidence that care plans are reviewed monthly. Service User plans detail how a service user’s personal hygiene needs are to be met. At the time of the inspection there were three service users with pressure sores. There is assessment documentation on file to look at tissue viability. Pressure care monitoring forms are completed and forwarded to the Quality Assurance Manager on a monthly basis. The home can access pressurerelieving equipment from the Primary Care Trust. Other risk assessments observed were for moving and handling needs, the use of bed rails, and nutritional status. The manager informed the inspector that the home tries hard to promote continence. Incontinence aids are sourced via the Primary Care Trust. Service users are encouraged to keep their own G.P. Recent difficulties have been experienced by the home re the present G.P surgery being unable to accept any more patients and the registered manager is looking for other available surgeries. Each service user can keep their own optician and the manager said that service users receive an annual eye test. Referrals for a hearing test go through the Community Audiologist service and they visit the home on a regular basis. The home works closely with the dietician and nutritional risk assessments were observed in care plans. Weight monitoring was observed in the care plans, along with action plans for service users who require extra care with eating/feeding. The home employs two activities co-ordinators, who are employed on a job share basis. The activities co-ordinator undertakes exercise classes with any service user wanting to join in. Chiropody and physiotherapy services can be accessed an extra cost to the service user. Dental services are accessed on a needs only basis via the community dental services or a local dentist. The home has a policy and procedure for the care of the dying and death. It includes procedures for the expected death of a service user, the unexpected death of a service user, Care of the Family and Organ donation. Every effort is made to ensure the service users stay in the home, and importance is placed upon the comfort and care of a service user who is dying. The home tries to make the environment soothing by playing tranquil music if wanted. The home involves the service users and their families, if appropriate, when trying to ascertain an individuals wishes regarding dying and death This information is gathered as soon as is feasible. BUPA Highclere Nursing Home DS0000019228.V271888.R01.S.doc Version 5.0 Page 12 The homes qualified nurses following an assessment by the G.P administer appropriate pain relief. BUPA Highclere Nursing Home DS0000019228.V271888.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 and 15. Service users engage in appropriate leisure activities inside and outside of the home, allowing individuals to pursue their own interests and hobbies. Service users are able to receive visitors at the home and there are no restrictions imposed on visiting unless requested by the service user. The presentation and standard of food is of a very high standard and meets the nutritional needs of service users. EVIDENCE: BUPA Highclere Nursing Home DS0000019228.V271888.R01.S.doc Version 5.0 Page 14 Care plans showed routines of daily living and included bathing, rising and retiring times and preferences for food and mealtimes. Religious observance are recorded in the care plans. Each care plan has a section that records each service users preferred social, recreational and leisure activities. Service users interests are recorded in the initial assessment and the inspector saw evidence of this. Some of the social activities that take pace in the home are Bingo, card games, a monthly church service, which is held in the home, and the hairdresser and barber visit regularly. The home does not have a set timetable for regular activities, but the manager stated that they try to cater for individual needs, and the inspector saw evidence of this in care plans. Service users are able to receive visitors in the privacy of their own rooms, and are able to choose whom they see and do not see. There are no restrictions on visiting, and this is documented in the service users guide. Involvement by local community groups includes the local nursery, a regular church service in the home, a lunch club and regular visits by the hairdressers and barbers. Service users are offered a choice at every mealtime. The main meal is served at lunchtime with a choice of main meal and sweet. There is a cook available until 7.oopm and any requests made regarding the evening meal can be accommodated. In the lounge, a small bar area offers hot and cold drinks at all times of the day. Evidence was seen in the care plans of nutritional screening and the home has had input from the dietician. The menu is rotated on a five weekly cycle. The dining area is bright and spacious and meals take place in two separate sittings. There are two meal sittings and the first is for service users who require assistance with feeding. The inspector was informed that independent eating is encouraged for as long as possible. BUPA Highclere Nursing Home DS0000019228.V271888.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): These standard were not assessed during the inspection. EVIDENCE: BUPA Highclere Nursing Home DS0000019228.V271888.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): These standards were not assessed during the inspection. EVIDENCE: BUPA Highclere Nursing Home DS0000019228.V271888.R01.S.doc Version 5.0 Page 17 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): These standards were not assessed during the inspection. EVIDENCE: BUPA Highclere Nursing Home DS0000019228.V271888.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 and 38. The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. The management approach of the home creates an open, positive and inclusive atmosphere. Various methods of measuring quality assurance are in place ensuring that the quality standards that apply to service provision are maintained to a prescribed standard and, in relation to service users requirements, are not compromised. There are clear and consistent policies in place to ensure the money and property of services users is protected. Service users benefit from having staff who are supervised and whose performance is appraised regularly. BUPA Highclere Nursing Home DS0000019228.V271888.R01.S.doc Version 5.0 Page 19 The homes record keeping and written policies and procedures comply with current legislation and recognised professional standards ensuring service users’ rights and best interests are safeguarded. There are systems within the home that are used to ensure that service users health, safety and welfare are protected and promoted. EVIDENCE: The manager is a Registered General Nurse and has been the manager at BUPA Highclere for approximately five years. The registered manager is due to leave her post at BUPA Highclere for another post with another organisation in the next five days. The Deputy manager who has been in post for six months will be acting manager until another manager is appointed. She will receive regular support from another registered manager from another nearby home. At the time of the inspection the registered manager had completed her Registered Managers Award. There are clear lines of accountability and the inspector saw the BUPA flow chart. The operations manager carries out monthly visits and these are sent to the Commission. The home operates three monthly staff meetings for all staff and more regular smaller group meetings. There is an equal opportunities policy in place and this was looked at during the inspection. The home has just completed an annual service organisation profile. This takes the form of a questionnaire, designed to allow the manager to describe the way they see their job, the organisation, their managers and their customers. All this information is collated and produced in a report, which the inspector looked at. A resident’s satisfaction survey has been undertaken in November. Accidents, pressure sores and complaints are monitored either monthly or three monthly and this information is sent to the organisations quality assurance manager. There is a suggestion box in the reception area of the home and anyone can make use of this. There is a folder containing compliments and thank you letters, mainly from the relatives of service users. The homes policies and procedures files were extensive and evidence was seen of policies being updated. Insurance certificates for the home are on display in the main reception area of the home. Service users are encouraged to look after their own financial affairs where at all possible. At the time of the visit there was one service user who was able to do this. BUPA Highclere Nursing Home DS0000019228.V271888.R01.S.doc Version 5.0 Page 20 All financial transactions are undertaken by a bursar employed by the home. The manager does not undertake the role of appointee for any service users. Secure facilities were observed for the safe-keeping of money and valuables and record and receipts are kept of possessions left for safe keeping. There is evidence to demonstrate that staff receive formal supervision at least six times a year and an annual appraisal. Service users can have access to their records if they wish to. The records maintained for health and safety are in good order. The homes policies and procedures cover a wide range of issues. All confidential information is kept in secure areas of the home. Records for fire safety and are comprehensive and up to date. A fire manual covers the homes fire procedures, practice fire drills, fire prevention, maintenance of escape routes, fire alarm testing, emergency lighting testing and door maintenance. A generic fire risk assessment for the home is in place and there is evidence that this has been agreed with the fire officer. Service reports are in place for the maintenance of the lifts, dated 09/09/05, hoists, dated 01/02/05, PAT testing, dated Nov 2005, hard wiring, dated 21/01/2003, gas appliances, dated 03/06/05 and water chlorination, dated 12/04/05. Infection Control guidelines are available for staff. The homes incident and accident book is completed legibly. The latest visit to the home from the Environmental Health was 07/07/05 and no requirements were made. Records are available for fire safety. These are comprehensive and up to date. A fire manual covers the homes fire procedures, practice fire drills, fire prevention, maintenance of escape routes, fire alarm testing, emergency lighting testing and door maintenance. Fire training and Moving and Handling training is up to date for all staff. All health and safety maintained by the home were thorough and of a high standard. The home is to be commended. BUPA Highclere Nursing Home DS0000019228.V271888.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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 3 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 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 BUPA Highclere Nursing Home DS0000019228.V271888.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 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. Refer to Standard Good Practice Recommendations BUPA Highclere Nursing Home DS0000019228.V271888.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 BUPA Highclere Nursing Home DS0000019228.V271888.R01.S.doc Version 5.0 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!