Inspection on 16/03/06 for Four Seasons

This inspection was carried out on 16th March 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Four Seasons 05/04/07

Four Seasons 13/07/05

Four Seasons 13/07/05

Four Seasons 13/07/05

Four Seasons 13/07/05

Four Seasons 08/02/05

Four Seasons 08/02/05

Four Seasons 08/02/05

Four Seasons 08/02/05

Four Seasons 16/06/04

Four Seasons 16/06/04

Four Seasons 16/06/04

Four Seasons 16/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Four Seasons Breightmet Fold Lane Bolton Lancashire BL2 5NB Lead Inspector Mike Murphy Unannounced Inspection 16th March 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 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. Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Four Seasons Address Breightmet Fold Lane Bolton Lancashire BL2 5NB 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) 01204 392005 01204 393005 Southern Cross Healthcare Services Limited Mrs Jacqueline Mellor Care Home 121 Category(ies) of Dementia - over 65 years of age (54), Old age, registration, with number not falling within any other category (55), of places Physical disability (8), Terminally ill over 65 years of age (4) Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 121 services users, to include: up to 55 service users in the category OP (Older People) over 65 years of age; up to 54 service users in the category DE(E) (Dementia over 65 years of age), with 1 named service user (JR) in the category of DE (Dementia under 65 years of age); up to 4 service users in the category TI (E) (Terminal Illness over 65 years); up to 8 service users in the category PD (Physical Disability under 65 years of age), within these, 2 places for named service users (BS and JC). A maximum of 29 service users in the above categories can receive nursing care. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 13th July 2005 2. 3. Date of last inspection Brief Description of the Service: Four Seasons is a 121-bedded care home providing a service to mainly older people, which include general nursing, dementia and residential care. The Home is also registered to provide care for eight younger people with a physical disability.The Home is situated on a bus route about 2 miles from Bolton Town Centre.The premises are purpose built on two levels with two lifts to the first floor.All bedrooms have en-suite facilities. Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the home’s second of the two annual inspections for the inspection year 2005 to 2006. The inspection was conducted by 2 inspectors and took place over six hours. The inspection included discussion with residents and their relatives, a tour of the premises, inspection of care and other records maintained at the home, discussion with management and staff, and consideration of responses in returned questionnaires sent to residents, their supporters and others who visit the home such as social workers, doctors and nurses prior to the inspection. What the service does well: What has improved since the last inspection? What they could do better: Whilst the home is generally maintained to a high standard there were some decorating and ventilation issues identified and which are addressed in the body of this report. Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 Page 6 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. Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 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 Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 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): 3,4,5. Standard 6 does not apply to this home. The home ensures that all prospective residents are appropriately assessed prior to admission to the home and provides them with appropriate information that helps to enable them to make an informed choice about where they live. This is essential to ensure that the home is able to meet the health and social care needs of prospective residents. EVIDENCE: Inspection of care records on each unit within the home revealed that all prospective residents undergo a formal pre-admission assessment that is conducted by a senior member of staff from the home. Records of assessment revealed that all the relevant activities of daily life were assessed appropriately and any areas of need in these areas identified. Such an assessment ensures that the home identified precisely what prospective needs are and that the home will be able to provide the care that individual needs. Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 Page 9 Discussion with residents and their relatives, management and staff, and inspection of care records indicated that the care and accommodation provided were meeting residents assessed needs. Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 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): 7,8,9,10,11. The health and personal care needs of residents on all units at the home were being assessed and met appropriately. Resident’s medicines were being appropriately managed and staff interacted and assisted residents sensitively and appropriately during the inspection. These are all important measures that help to ensure that residents are receiving appropriate care and treatment. EVIDENCE: The health care records of 20 residents who live on each of the four units at the home were sampled and inspected on this occasion out of a total of 113 who were resident at the time of inspection. These were found to contain care plans that were initially based on the pre-admission assessment referred to earlier. Care plans addressed the health, personal and social care needs of residents – including any specialist needs for example the needs of resident’s on the EMI units - and were evaluated at least monthly. Risk assessments, that seek to protect resident’s health and safety were also recorded in respect of residents skin integrity, mobility, and nutrition (including weight monitoring) and other relevant areas and were evaluated at least monthly. Where risk assessments indicate that a resident is at risk the risk assessment is Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 Page 11 supplemented by a care plan that seeks to minimise the risk identified. The arrangements for resident’s medicines were secure and appropriately documented. Discussion with residents indicated that staff at the home treat them with respect and seek to maintain resident’s dignity and privacy particularly when personal care is being provided. Examples of such comments are ‘ the staff treat me well’, ‘I am properly looked after here’, ‘I can get up when I want to in the morning’. Residents confirmed and this was also evident in discussion with staff and inspection of care files, that they are able to receive health care services appropriately, this included access to specialist medical services (including psychiatric services if required), opticians, dentists, and chiropodists. This is important for resident’s to maintain as good health as possible. All residents were registered with a local GP. Care planning was based on the care and support individual resident’s required. Appropriate measures were in place to ensure that resident’s who are coming to the end of their lives are treated with dignity and compassion. The palliative care needs of residents are supervised by qualified nurses who have undergone special training in this sensitive area. Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The routines of daily life were as flexible as possible in a communal living setting. Residents living on each Unit were able to participate fully in a wide range of social and leisure activities that are organised within the home. Meals provide a balanced and varied diet. Both activities and meals are very important aspects of residents daily life in a home. EVIDENCE: The home is extremely active in the provision of a wide range of leisure and social activities and facilities. Residents from each unit are involved in the varied group activities on offer at this home. A programme of activities was prominently displayed in the home – this enables residents to be aware what is available and to choose what activities they wish to participate in. This programme of activities is supplemented by entertainers occasionally coming to the home, and a range of outings, that provide appropriate opportunities for residents to experience life and leisure outside the home. The manager and staff are commended for ensuring that resident’s are able to enjoy such a varied programme of activities. Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 Page 13 Residents and their relatives stated that there were no unreasonable restrictions to visiting at the home. Relatives said they were made to feel welcome at the home when they visited and that they were kept informed of any changes or developments in the condition of their relative. Residents spoke very positively in respect of the food provided for them by the home. Menus are balanced and varied diet and provide choice. Resident’s meals are prepared on site. Breakfast and Lunch were observed on the day of inspection. These meals were hot and substantial. Staff served and assisted residents appropriately and sensitively. Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Appropriate procedures are in place to ensure that residents and their relatives feel comfortable with making a complaint if necessary, and to prevent residents becoming victims of abuse. These are important areas that are essential to the protection of resident’s in a care home, many of whom are extremely vulnerable. EVIDENCE: Discussion with residents and their relatives revealed that they were aware of how to and were provided with information that enabled them to make a complaint if they desired. A comprehensive and accessible complaints procedure is prominently displayed in the home, and includes details of how complainants can contact the CSCI if wish. Resident’s felt comfortable and confident enough to raise a complaint if they felt it necessary to do so. They also stated that when concerns were raised these were addressed promptly by the manager of the home. Inspection of policies and procedures operated at the home, discussion with staff and inspection of staff training records indicated that staff were aware of the importance of protecting resident’s from potential abuse and how to communicate any concerns they may have in this area. Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,24,26. Residents are provided with a home that appears to be structurally well maintained and that provides a pleasant, clean, warm and comfortable environment. EVIDENCE: The home provides a pleasant purpose built environment for residents on four specialised units within the home – 2 Emi nursing units, 1 general nursing unit and 1 personal care (‘residential’) unit. Each unit provides communal lounge and dining areas as well as individual resident’s bedrooms. All areas of the home were very clean and free of malodour on the day of this inspection. Residents and their families said that they are encouraged to personalise bedrooms with resident’s own personal items and such rooms were comfortably and appropriately furnished. Lounge and dining areas were appropriately and comfortably furnished and equipped with TV’s, VCR’s and music centres – and ‘quieter’ areas are also available for residents to sit in. Residents can access all areas of the home via passenger lifts and they can Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 Page 16 also access pleasant garden areas. In the main the home was well decorated. However one of the EMI units (‘Spring’ unit) was in need of redecoration. The inspector was informed this work had been schedule to commence the week following the inspection. It is also noted that the need to improve the ventilation in the corridors of ‘Spring’ and ‘Winter’ units identified in the last report remains outstanding. The home also has a recreational area on the 1st floor of the home that is a ‘social’ club for residents. Appropriate environmental aids and adaptations were in place throughout the home. Individual resident’s needs for specialist equipment/aids are addressed following assessment by the appropriate health care professional. Arrangements for residents laundry needs were appropriate. The home has taken appropriate measures in the laundry and elsewhere in the home to minimise the spread of infection. Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 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): 27,29. Staffing arrangements at the home appeared to be appropriately managed and suitable to meet the assessed needs of residents at the home. EVIDENCE: Inspection of staffing rotas provided by the home indicated that staffing provision at the home complied with the current minimum requirements that apply to care homes for older people. Discussion with the manager and senior staff indicated that they were of the view that staffing levels were appropriate to meet the current dependency levels of resident’s on each unit at the time of inspection. Inspection of training records revealed that staff are provided with well organised and appropriate induction training at the commencement of employment, regular training in moving and handling, fire safety, basic food hygiene, protection of vulnerable adults and other appropriate care topics. Care staff have either obtained an NVQ 2 qualification (or above) in care or a currently studying to obtain such a qualification. Qualified nursing staff are provided with opportunities to update their skills and knowledge through accessing a variety of training courses. Training records were being maintained. Inspection of 3 recently employed staff personnel files revealed that these contained an application form (including health declaration), 2 written Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 Page 18 references, a Criminal Records Bureau check (including a ‘POVA first’ check), proof of identity and evidence of induction training. Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,38. The home continues to be effectively and efficiently managed by the registered manager. This is important for resident’s, their relatives and staff need to have confidence in and access to competent managers. EVIDENCE: The registered home manager is a very experienced registered nurse manager and has completed an NVQ4 in management. Discussion with residents, their relatives, and staff employed at the home indicates that the registered manager adopts a management approach that is open, supportive, positive and inclusive. A robust and varied quality assurance system is operated that seeks to measure the satisfaction of residents and their relatives with the care and accommodation provided by the home. This includes the registered provider’s Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 Page 20 monitoring visits to the home, the registered manager’s regular audits, periodic resident’s and relative’s questionnaires and regular resident and staff meetings. In addition regular management meetings are held. Discussion with resident’s and their relatives indicated that they are consulted about their satisfaction with the care and services provided and feel that their views are valued. The following certificates of inspection/service records were found to be satisfactory on this occasion; electrical systems/equipment, fire fighting equipment and the fire alarm system, fire safety training, fire safety risk assessment, fire procedure, testing of fire safety systems, passenger lift/lifting equipment, accident records/monitoring, monitoring of hot water temperatures and inspection/servicing of thermostatic mixer valves, general and specific health and safety risk assessments, and control of clinical waste disposal. However a current certificate of gas safety was not available for inspection. Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X X 2 Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP19 Regulation 23 Requirement That an action plan to improve ventilation to corridors within winter and spring units corridors is submitted to the CSCI. (Outstanding requirement) That a copy of the current gas safety certificate for the home is submitted to the CSCI That an action plan detailing the proposed/completed decoration programme for Spring unit is forwarded to the CSCI Timescale for action 31/05/06 2. 3 OP38 OP19 13 23 30/04/06 31/05/06 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 OP7 Good Practice Recommendations That all daily statement entries in care records are timed Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 Four Seasons DS0000005678.V286155.R01.S.doc Version 5.1 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. 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