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Inspection on 23/06/05 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 June 2005.

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. Service users spoken to said that the staff were " very helpful and caring". There is an effective complaints procedure with all complaints and concerns being acted upon promptly, within stated time scales.

What has improved since the last inspection?

On-going improvements to the environment have enhanced several service users own bedrooms and some communal areas. During the previous announced inspection a requirement was made for entries made on the medication charts to be completed by all staff who administer medicines to service users. It was pleasing to see that there were no omissions observed during this inspection.

What the care home could do better:

A requirement was made during an announced inspection on the 17th and 18th November 2003 to ensure that door wedges are not used to hold open fire doors and that serious consideration is given to alternative ways to keep doors open. Although several doors have been fitted with door guards this is not adequate to ensure the safety of all service users who wish to keep their doors open and this will remain a requirement of this report.

CARE HOMES FOR OLDER PEOPLE BUPA Highclere Nursing Home Chapman Avenue, Downs Barn Milton Keynes Buckinghamshire MK14 7NH Lead Inspector Barbara Mulligan Unannounced 23rd June 2005 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 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service BUPA Highclere Nursing Home Address Chapman Avenue, Downs Barn, Milton Keynes, Buckinghamshire, MK14 7NH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01908667568 01908 691366 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 Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 10th December 2004 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 ther 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 don’t, 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 Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 23rd June 2005 at 10am on a weekday by Regulation Inspector Ms. Barbara Mulligan. The inspection consisted of looking at documentation, records, policies and procedures, discussion with staff and service users and the registered manager and a tour of the premises. What the service does well: What has improved since the last inspection? On-going improvements to the environment have enhanced several service users own bedrooms and some communal areas. During the previous announced inspection a requirement was made for entries made on the medication charts to be completed by all staff who administer medicines to service users. It was pleasing to see that there were no omissions observed during this inspection. BUPA Highclere Nursing Home Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. BUPA Highclere Nursing Home Version 1.10 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 Standards Statutory Requirements Identified During the Inspection BUPA Highclere Nursing Home Version 1.10 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 standard(s) Not assessed on this occasion. EVIDENCE: BUPA Highclere Nursing Home Version 1.10 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 standard(s) 9, 10. The manner in which personal care is delivered ensures the service users are treated with respect and dignity and that their right to privacy is upheld. The medication policies and procedures are clear and there is consistent implementation resulting in safe working practices which ensures that service users are not put at risk. . EVIDENCE: BUPA Highclere Nursing Home Version 1.10 Page 10 Medication is kept in two secure trolleys, one on the ground level that is attached to a wall, and one on the upper level that is kept in the nurse’s office that always remain locked. In this room oxygen and medical equipment is stored and there is a lockable fridge used to store some medications. Temperature records of this fridge are maintained. Medication is administered via a monitored dosage system and the home uses a local pharmacy. Inspection of MAR charts showed no signature omissions. Photographs of service users, on medication charts, are used for identification. Several N.M.C. booklets were observed regarding the administration of medicines. There is a medication policy in place and this covers all areas detailed in standard 9. The inspector looked at a BUPA Homely Remedy Policy that is endorsed by the homes G.P. Records of all medication received and returned are entered in a hard-back book, and when the medicines are returned the pharmacist signs and stamps the book to verify the return. The home uses controlled drugs and these are stored in a metal cupboard, which complies with the Misuse of Drugs Regulations 1973. The home uses oxygen cylinders and there is a separate policy and procedure for this. The manager was aware of the need to retain medication for a period of seven days after a service user has died. Single rooms ensure service users receive care from staff and health care professionals in complete privacy. Staff were seen knocking on service users bedroom doors before entering. Service users can have a key to their rooms if they wish. The home has a mobile telephone that service users can access if they wish to. There is also a telephone in the reception area. Service users clothes are named by their families, but when this is not practicable the homes staff will do it. BUPA Highclere Nursing Home Version 1.10 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 standard(s) 14 Systems in the home ensure that where appropriate service users are supported to exercise choice and control over their lives. EVIDENCE: Service users are encouraged to look after their own financial affairs whenever possible. There are two service users who are able to do this. If this is not practicable, families, or on occasions a chosen solicitor will be responsible for an individuals financial dealings. A small amount of personal allowance is held at the home for service users. An invitation to bring in personal items of furniture and other belongings is included in the service users guide and evidence of this was seen during a tour of the premises. Service users have access to their personal records if they wish. BUPA Highclere Nursing Home Version 1.10 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 standard(s) 16, 17 and 18. The home has an effective complaints procedure which ensures that service users are listened to and their concerns acted upon. There are effective adult protection policies in place ensuring service users are not at risk of harm or abuse. Service users legal rights are protected enabling them to exercise their legal rights directly and participate in the civic process if they wish. EVIDENCE: BUPA Highclere Nursing Home Version 1.10 Page 13 The home has a complaints procedure in place and this is included in the statement of purpose. Copies of the complaints procedure are available by the main reception area. The home has received three complaints from relatives and three complaints from one service user living in the home. All complaints were well recorded and responded to within stated timescales. Recorded complaints showed the action taken by the home and the outcome of the complaint. There is one on-going complaint that is being dealt with by the home. A copy of this complaint has been sent to the Commission for Social Care Inspection. The manager stated that complaints are monitored monthly and the home sends a monthly report regarding any complaints to the organisation’s Quality Assurance Manager. Eight service users opted to vote by post and this was facilitated by the home. The home can access Age Concern if any service user requires information regarding advocacy. Policies for whistle blowing and adult abuse are in place and all new staff are given copies of the whistle blowing policy. Copies of both policies are kept in the nurse office for all staff to have access to. Five staff had recently completed adult abuse awareness training that now enables them to carry out in-house training for other staff. The home has a financial policy for dealing with service users personal allowances and the bursar, employed to deal with service users money, carries out most transactions. Relatives will hand money or a cheque in for the service user, and the bursar will give the relative a receipt. The money/cheque is kept in a safe, until the bursar deposits it into the bank. The home has one main bank account and this is not held by BUPA. Within the one account each service user has a sub account, and they are allocated an account number. Service users can request a statement at any time, and the bursar will automatically send them out on a monthly basis. If the balance of a service users account falls below £12, the bursar will write to the service user, or their family if they manage the financial affairs, and request further funds. All services such as hairdressing, newspapers and chiropody are put on an invoice and given directly to the bursar to reconcile, so service users do not handle their personal allowances unless they request to do so. BUPA Highclere Nursing Home Version 1.10 Page 14 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 standard(s) 19, 20, 21,22,23,24,25 and 26 The standard of the environment within this home is good providing service users with an attractive and homely place to live. The overall quality of the furnishings and fittings is good ensuring the safety and comfort of service users. The garden is regularly maintained to keep it safe and accessible for service users. EVIDENCE: BUPA Highclere Nursing Home Version 1.10 Page 15 BUPA Highclere 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. The home is situated in a residential area of Milton Keynes and is within a short distance of local shops, church and a public house. BUPA Highclere offers all single room accommodation. Twenty-two rooms offer en-suite facilities, and those that don’t, have toilet and bathing facilities close by. A requirement was made during an announced inspection on the 17th and 18th November 2003 to ensure that door wedges are not used to hold open fire doors and that consideration is given to alternative ways to keep doors open. Although several doors have been fitted with door guards this is not adequate to ensure the safety of all service users who wish to keep their doors open and this will remain a requirement of this report. 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. The dining room is spacious, bright and overlooks the gardens. There is one small lounge on the upper floor that has been decorated with reminiscence furniture and this is available for service users to meet visitors, or they can also meet visitors in the privacy of their own bedrooms. Upstairs there is one toilet in each of the 3 corridors, one toilet in each of 2 bathrooms, two staff toilets and nine rooms have en-suites. Downstairs there is one toilet in each of the 3 corridors, one toilet in each of the 2 bathrooms, two staff toilets and nine rooms have en-suites. Grab rails, assisted baths and other aids were observed in place throughout the home. All doorways appeared to be wheelchair accessible and many parts of the building were open plan, making it easy for wheelchair users to manoeuvre around. The home has a call system in place with accessible facilities and this was installed in all service users rooms. The laundry facilities for the home were sited so that soiled washing does not come into contact with the kitchen. Hand washing facilities are sited in the laundry. The floors in the laundry were washable and the walls easily cleanable. Instructions were observed in the laundry regarding the washing of foul linen. Policies and procedures were observed for the control of infection, which includes the safe handling and disposal of clinical waste. A tour of the home showed that cleanliness in the bedrooms and the communal areas was maintained. There were two sluice areas, one on each floor. BUPA Highclere Nursing Home Version 1.10 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30. There are effective recruitment procedures in place to ensure service users are protected from harm. Service users benefit from a staff team who are appropriately trained to ensure that service users are cared for by skilled staff at all times. Staffing numbers are appropriate to ensure that the assessed needs of the service users are met. EVIDENCE: Rotas demonstrated that appropriate levels of staff are on duty across a twenty-four hour period. There is one vacancy for a deputy manager and vacancies for forty-eight hours for night workers. There will be another full time registered nurse vacancy at the end of August. The registered manager is in the process of recruiting appropriate staff to fill these vacancies. All staff receive an annual appraisal and training needs are identified during staff supervision. There were no staff members under the age of eighteen and there are no staff under the age of twenty one left in charge of the home at any time. Staff files are kept in the home. These are well maintained and contained all the necessary documentation as detailed in standard 34. BUPA Highclere Nursing Home Version 1.10 Page 17 All staff receive an induction programme based on Topps. This includes fire safety, moving and handling techniques and core skills training. One care staff has NVQ level 3 training and three staff are in the process of undertaking this training. Nine care staff have NVQ level 2 training and two care staff are undertaking this. Training records showed that staff are up to date with mandatory courses and there are regular staff meetings. Further training undertaken by staff includes Dementia Training, Renal Training, Continence Training, Nutritional Training and Diabetes Training. The maintenance manager has undertaken PAT Testing, LOLLER Training, Fire Training for Trainers and has attended a training day regarding the use and maintenance of hoists. The chef has undertaken a Hazard Analysis Critical Control Point training and an intermediate basic food hygiene certificate course. Housekeepers have completed NVQ level 2 in housekeeping. BUPA Highclere Nursing Home Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed on this occasion. EVIDENCE: BUPA Highclere Nursing Home Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 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 Standard No 16 17 18 Score 3 3 3 x x x x x x x x BUPA Highclere Nursing Home Version 1.10 Page 20 no Are there any outstanding requirements from the last inspection? 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 19 Regulation 23(4) Requirement The registered manager is required to ensure that door wedges are not used to hold open fire doors and that consideration is given to alternative ways to keep doors open. Timescale for action 30/10/05 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. Refer to Standard Good Practice Recommendations BUPA Highclere Nursing Home Version 1.10 Page 21 Commission for Social Care Inspection Cambridge House, Smeaton Close 8 Bell Business Park, Aylesbury Buckinghamshire 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 Version 1.10 Page 22 - 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. 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