Inspection on 08/05/07 for BUPA Highclere Nursing Home

This inspection was carried out on 8th May 2007.

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.

Other inspections for this house

BUPA Highclere Nursing Home 30/11/08

BUPA Highclere Nursing Home 23/01/06

BUPA Highclere Nursing Home 23/06/05

BUPA Highclere Nursing Home 10/12/04

BUPA Highclere Nursing Home 18/10/04

BUPA Highclere Nursing Home 08/01/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE BUPA Highclere Nursing Home Chapman Avenue Downs Barn Milton Keynes Buckinghamshire MK14 7NH Lead Inspector Philippa MacMahon Unannounced Inspection 8th May 2007 10:00 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 Highclere Nursing Home DS0000019228.V339806.R02.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 Highclere Nursing Home DS0000019228.V339806.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service BUPA Highclere Nursing Home Address Chapman Avenue Downs Barn Milton Keynes Buckinghamshire MK14 7NH 01908 667568 01908 691366 edwardssc@bupa.com www.bupa.com BUPA Care Homes (BNH) Limited 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) Cheryl-Ann Edwards 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.V339806.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Physical Illness ( Respite ) 40 years plus Date of last inspection 23rd January 2006 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.V339806.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was conducted over 6 hours starting at 10 am. The inspector looked at how well the home was meeting the national minimum standards set by the government and has in this report made judgements about the standard of service provided. The Registered Manager was the person in charge of the home on the day of inspection and was present throughout the inspection. The inspector toured the building and spoke to residents to find out what life in the home was like. Three residents were case-tracked. This means their care records were looked at in detail and the arrangements around their care observed. Each resident agreed to talk to the inspector in private to give a view of their care. The Commission for Social Care Inspection (CSCI) received a good response to the ‘Have your Say’ questionnaires it sent out prior to the inspection. 13 residents, and a number of relatives responded. The inspector examined records, policies and procedures, for all aspects of running a care home. A number of relatives visiting the home took time to talk to the inspector. The inspector would like to thank everyone who was involved in this inspection in anyway. What the service does well: Highclere offers the people who live there a comfortable, clean, wellmaintained home. The registered manager manages the home very well and good teamwork amongst all members of staff has been established. The people living at the home are well looked after and treated as individuals. Relatives and visitors are made very welcome at all times, and the communication between staff and families is very good. People who reach the end of their lives are provided with the best care possible, and their families are included in this care provision. BUPA Highclere Nursing Home DS0000019228.V339806.R02.S.doc Version 5.2 Page 6 The provision of meals and mealtimes are of a very high standard and much appreciated by the residents spoken to. Staff training and development is well established and is continually being updated in line with current initiatives. What has improved since the last inspection? What they could do better: 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 Highclere Nursing Home DS0000019228.V339806.R02.S.doc Version 5.2 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.V339806.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People who use the service experience good quality outcomes in this area. People who are interested in becoming a resident at the home have a preadmission assessment of their care needs, and have the necessary information to make an informed choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector examined a sample of care plans and found each one contained a comprehensive pre-admission assessment. This assessment forms the basis of the care planning process. The registered manager or her deputycarry out all pre-admission assessments. A copy of the homes service users guide was shown to the inspector and these are given to every resident and any prospective resident. This guide containes all the necessary information for the person to make an informed choice about where to live. The home does not have an intermediate care service. BUPA Highclere Nursing Home DS0000019228.V339806.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11. People who use the service experience good quality outcomes in this area. People who use the service are very well cared for and this is supported by good record keeping, risk assessments and support from other health care professionals in the community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector examined a sample of care plans and followed this up by meeting with the individual person. In each case the care plan reflected the persons individual care needs and the action required to meet them. The home is in the process of changing the documentation to a more user friendly format and training was in progress during this inspection. The old style of documentation contains a huge amount of information that has been collected in some cases for a number of years which makes it difficult to find the relevant information. This information will be archived appropriately once the new system is in place. BUPA Highclere Nursing Home DS0000019228.V339806.R02.S.doc Version 5.2 Page 10 Regular review of the care delivered is recorded and the care plans updated accordingly. Evidence of the relatives being involved in the care planning process was apparent. Risk assessments are in place covering areas such as nutrition, moving and handling, and prevention of pressure ulcers. The inspector noted in one care plan that the resident had lost 3Kg in weight in one month. This had not been acted on or comment made anywhere in the care plan. This is a significant weight loss and in need of following up. The Registered Manager is to look into this issues. How risk assessments are used in the home should be reviewed as the people using the service could have unmet needs. The residents are able to take part in an exercise programme if appropriate and are encouraged to walk in the lovely garden. Communication between the local GPs, dietician, Hospice, and specialist nurses, is good and their services are readily accessible. The home is in the process of becoming part of the local End of Life Project, and will be actively involved in providing palliative care as part of this National Initiative. Sadly there had been two recent deaths in the home and the family visited the home during this inspection and both families wished to tell the inspector about their experiences. The felt very much a part of the team and very well supported by the staff. Their relative received the best possible care from the staff. One comment was that her mothers last wishes had been met in that she wanted to be a lady for 2 weeks, and the home had provided this for her in every way. The inspector observed staff assisting the residents in a kindly and respectfull manner. It is apparent that staff understand issues of privacy and dignity by always by always addressing the residents by their preferred term of address, and knocking on doors before entering a room. One of the Commissions Have your say about Highclere questionnaires contained comments about how they are treated with dignity and respect. Many of the comments were very posative about the quality of the care provided overall. The medication systems were examined and found to be overall in good order. The record keeping was up to date and complete. The registered nurse spoken to was unclear about the disposal of medication and it is recommended that the system for the disposal of unwanted medication should be discussed with the nurses to ensure correct procedures are always in place. The inspector noted two oxygen cylinders were free standing in the nursing office rather than being in a stand or trolley. This could be a risk to the health and welfare of both staff and residents as they could fall over and cause damage. The registered manager immediately took these out of commission as a delivery of oxygen cylinders with appropriate storage equipment had been delivered that day. BUPA Highclere Nursing Home DS0000019228.V339806.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People who use the service experience good quality outcomes in this area. People who use the service have the opportunity to take part in a varied social and recreational activities programme should they wish to. Visitors are always welcome in the home. Meals provided are of a high quality and much appreciated by the residents. The home is able to meet the needs of people of different race, culture, and religion. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector noted in the care plans examined that there was a life story written, and a daily diary outlining the social and recreational activities that had been enjoyed. This is good practice and ensures that the residents individual lifestyles are considered. There is an activities co-ordinator who works 15 hours a week and a vacant post of the same hours that is being recruited into. The activities programme is being developed with the residents and on the day of this inspection a number of residents had gone out to a luncheon club, and in the afternoon a service of Holy Communion with hymn singing took place in the sitting room. A good number of residents were present at this service. BUPA Highclere Nursing Home DS0000019228.V339806.R02.S.doc Version 5.2 Page 12 The Manager told the inspector about a previous resident who was of Asian nationality and how the home was able to meet her cultural and religious needs. This included having members of staff who were able to speak the same language. The home has recently implemented a monthly newsletter called Highclere Insight and a copy was presented to the inspector. The content of the newsletter covers any newsworthy item about what is going on at Highclere and a quiz. Visitors are always made very welcome in the home and a number spoken to during the inspection said that they really enjoyed coming into the home and felt they were a part of the family. Visitors are able to make themselves a drink and are always aware that they can also joined the residents at mealtimes. The inspector joined the residents for lunch in the dining room that was well laid out to provide an opportunity to socialise without being too crowded. Tables were laid with attractive tablecloths and napkins, and a vase of flowers. The lunch served was attractively presented and the vegetables were served at the table. The residents spoken to all spoke very highly of the quality and choice of food presented, and enjoyed being able to talk to the cook about their personal likes and dislikes with regard to the food. There are always two sittings for lunch and this is to ensure that those residents requiring assistance and more time to eat their meal are able to do so in a relaxed and unhurried manner. The inspector met with the cook and examined the planned menus and discussed how these are drawn up. The cook takes great pride in cooking every dish using fresh ingredients, and vegetables. An audit of the food consumed and the nutritional value is recorded showing that the residents always have a well balanced wholesome diet. As a result of a satisfaction survey recently carried out changes were made to the timing of the main meal of the day. This proved to be unsatisfactory after a trial period and the main meal has been returned to lunch time. This is good practice in that the residents wishes are being carried out rather than them having to conform with what is easiest for the home. BUPA Highclere Nursing Home DS0000019228.V339806.R02.S.doc Version 5.2 Page 13 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): 16 and 18. People who use the service experience good quality outcomes in this area. People living in the home are encouraged to raise any conerns they may have, at the earliest opportunity. about the care provision. People living at the home are protected from any form of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector examined the homes complaints procedure and discussed how this is managed by the home. The registered manager welcomes any complaints or concerns and actively encourages residents and relatives to raise any issues they have at the earliest opportunity. The training programme for all staff was examined and showed that training in safeguarding adults is provided, and is regularly included in the training programme. BUPA Highclere Nursing Home DS0000019228.V339806.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the service experience good quality outcomes in this area. The home is cleaned and maintained to a high standard and offers the people living there a comfortable, safe, and hygienic home to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector toured the building and the gardens. Overall all areas were found to be cleaned to a high standard, and the furnishings and fittings are of a good quality. There were no offensive odours, and the rest of the building and grounds are well maintained. Residents individual rooms are personalised with the persons own items of furniture, pictures, and photographs. The inspector met with the Maintenance person and discussed the ongoing maintenece checks that are undertaken and the accompanying records that support this. BUPA Highclere Nursing Home DS0000019228.V339806.R02.S.doc Version 5.2 Page 15 There are plans in place to upgrade the home as it is now 22 years since the home was built. These plans include the provision of a Conservatory, french doors from the day room onto a patio area, resurfacing of footpaths, and making good of the raised flower beds. A quote for these works to be done was received by the manager at the time of this inspection. BUPA Highclere Nursing Home DS0000019228.V339806.R02.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): 27, 28, 29 & 30. People who use the service experience excellent quality outcomes in this area. People living in the home are looked after by appropriate numbers and skill mix of staff, who are trained to carry out their duties. Robust recruitment policy and practices in place to support and protect the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector examined staff rosters and found that appropriate numbers and skill mix of staff on on duty at all times. There is a vacancy for a deputy manager that is being actively recruited into, along with a part-time activities person. The manager is also recruiting bank staff as the home does not employ agency staff, and 3 of the present group of staff will being going on expended leave at the same time later in the year. This is good practice and is to be commended. The percentage of care staff who have achieved a national vocational qualification in care has exceeded the 50 target as set out in the national minimum standards. Other staff including housekeepers, catering and laundry staff have also undertaken training to achieve national vocational qualifications. The inspector examined a sample of staff files and found that the recruitment procedures are robust and all necessary checks had been carried out. BUPA Highclere Nursing Home DS0000019228.V339806.R02.S.doc Version 5.2 Page 17 There is a staff training and development programme in place and evidence of induction training and ongoing training in all aspects of working in a care home. Many of the staff have worked in the home for many years and told the inspector that they still find enjoyment and fulfilment in their work. BUPA Highclere Nursing Home DS0000019228.V339806.R02.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): People who use the service experience good quality outcomes in this area. The home is well managed and the good systems are in place to safeguard the residents and staff working in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered manager met with the inspector and discussed the overall management of the home. Although relatively new in post the manager clearly is well qualified and competent to manage the home, having had previous experience of management within the same company. She has been very impressed and supported by a stable staff team, and the senior management team of the company. The inspector noted good teamwork in progress and all the staff spoken to had a good working knowledge of the individual residents and their care needs. The manager has an open door BUPA Highclere Nursing Home DS0000019228.V339806.R02.S.doc Version 5.2 Page 19 style of management and holds regular staff meetings to encourage good communications and working practices. The company has a quality assurance system in place that requires the manager to audit all aspects of running a care home and to report back on a regular basis. Customer surveys are carried out and the last one was in September 2006 and was in relation to the provision of meals. The outcome of the survey was shared with the residents and staff and an action plan was produced and has been worked on as was indicated earlier in this report. The inspector met with the homes burser who explained the system for managing the residents incidental expenditure. The company has a very clear system in place that shows all monies received, expenditure made, and receipts kept. The home does not act on any residents behalf this is generally undertaken by the family or other appointed representative. All staff receive mandatory training in fire safety, food hygienne, and moving and handling and records of training undertaken are kept. The maintenece person showed the inspector the regular servicing and maintenance records for the boilers, water, electrical equipment, the lift, and manual hoist. The housekeeper met with the inspector and described the storage and safe practices in place with regard to the cleaning products in use in the home. The induction and foundation training for all staff imlemented in the home meets the requirements of the Skills for Care Council, and includes all safe working practices . BUPA Highclere Nursing Home DS0000019228.V339806.R02.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 3 8 3 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X 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 X 3 x 3 X X 3 BUPA Highclere Nursing Home DS0000019228.V339806.R02.S.doc Version 5.2 Page 21 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. 1 Refer to Standard OP9 Good Practice Recommendations It is recommended that the system for the disposal of unwanted medication should be discussed with the nurses to ensure correct procedures are always in place. BUPA Highclere Nursing Home DS0000019228.V339806.R02.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 © 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.V339806.R02.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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