Key inspection report
Care homes for older people
Name: Address: Old Gates Nursing & Residential Home Livesey Branch Road Feniscowles Blackburn Lancashire BB2 5BU The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Graham Oldham
Date: 0 4 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People
Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home
Name of care home: Address: Old Gates Nursing & Residential Home Livesey Branch Road Feniscowles Blackburn Lancashire BB2 5BU 01254209924 01254200948 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.bupa.com BUPA Care Homes (CFHCare) Ltd care home 90 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home with Nursing - code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Physical disability - Code PD, Dementia Code DE. The maximum number of service users who can be accommodated is: 90. Date of last inspection Brief description of the care home Old Gates Nursing and Residential Home is owned by BUPA Care Homes Limited. The home provides long stay and respite care for up to 90 adults who require help with personal care or who have nursing care needs. The home is a purpose built, single storey building. It comprises one reception area and three separate houses. Holly House accommodates people with nursing and Care Homes for Older People
Page 4 of 27 Over 65 0 90 0 90 0 90 2 0 1 0 2 0 0 9 Brief description of the care home personal care needs. Rowan House accommodates people who have a diagnosis of dementia and Cherry House accommodates people who require assistance with personal care. Each house has its own lounge/dining area and small kitchen. There are 30 single bedrooms in each. The bedrooms do not have en-suite facilities but there are sufficient bathrooms and toilets close to bedrooms and communal areas. Old Gates is situated in a residential area, close to local amenities, including a Post Office, churches, public houses and shops. It stands in landscaped grounds with several garden and patio areas. There are adequate car parking spaces. An information pack about Old Gates is sent out to anyone making enquiries about the home. The latest Commission for Social Care Inspection report is on display in the foyer and copies are available from the manager on request. The weekly fees are varied and will be given upon enquiry but follow the social services fee structure. Additional charges were made for hairdressing, newspapers and toiletries. Care Homes for Older People Page 5 of 27 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection, which included a visit to the home, took place on the 6th February 2010. Much of the information gained was obtained from talking to people who used the service and staff members. The views of people who used the service were obtained on a variety of topics. Four people were case tracked. Case tracking gave the inspector an overall view of the specific care for the individual resident by checking the plans of care, other documentation and talking to residents and staff. Two staff members were questioned about the care of the residents case tracked. Some of the views have been reported collectively with specific comments contained within the body of the report. The inspector took detailed notes during the inspection, which have been retained as evidence. Staff were directly and indirectly observed carrying out their tasks and interacting with residents. Paperwork examined included plans of care, assessment Care Homes for Older People
Page 6 of 27 documentation, policies and procedures or documents relevant to each standard. A tour of the building was conducted. The service returned a self assessment questionnaire which told us of the current and projected standard for the home. Notifications, which are events the home tell us about were also used to influence the inspection. Care Homes for Older People Page 7 of 27 What the care home does well: People who used the service said, I came with my daughter and looked around. Staff told me what I needed to know and I was in hospital. My daughter and husband came round several homes and came up with here. He only lives across the road. We had enough information to choose here. People were given enough information to make an informed choice to enter the home. The good assessment process helped ensure people entering the home were suitably placed. One person who used the service said, I am aware of my care plan and we get involved. They keep my family informed of my care. Plans of care contained excellent details for staff to deliver care and had been regularly reviewed to ensure the up to date needs of people who used the service were recorded. This helped ensure people received the care they needed. People who used the service had access to specialists to help meet their health care needs. People who used the service said, They shut the curtains and the door and keep care private and they treat me privately. People who used the service were treated privately and this helped retain their dignity. A person who used the service said, I can make my own choices. The plans of care contained good information about the choices people could make which helped them retain some independence. People who used the service said, Visitors are welcome. My husband comes every day and my daughter comes to visit me and she can come any time. Visiting was encouraged to help people use the service socialise. People who used the service said, I am on a restricted diet and they have gluten free food for me. Its OK and the food is very good. The food served at the care service met peoples satisfaction. People who used the service said I feel safe here. I can talk to someone if I have to to voice my concerns and I would be able to voice my concerns but so far so good. There were complaints and safeguarding procedures to help people feel secure. Bedrooms were satisfactory for the people who resided in them and they said, my room is suitable. I have made it more homely and the room is all right. There were sufficient numbers of well trained staff to help meet the needs of people who used the service. People said, you can talk to them if you have anything to ask. Staff are friendly and helpful. I am satisfied with my care and they look after me OK and the staff are nice. I like it here. I am very satisfied. The good attitude of staff was appreciated by people who used the service. Staff said, I love it and have been here nine years. I did my work experience here and Care Homes for Older People
Page 8 of 27 have worked on all three units but like it here because it is more hands on. I get supported and I feel the manager of the unit is like my friend. We have supervision. I get enough training to perform my role, I like my job because I like caring. With good support I think I do my job well. I think there is a good staff team. We have meetings and can discuss issues then and I think it is going better now that we have a new management structure. The new manager is bringing in changes. I have been here for years. I like it because its challenging. I love working with people and give respect to someone who is older and needs help respect and dignity. I get supported there is more support now. The managers door is open. There is a good staff team. Staff felt supported, happy in their work and as a team gave a good service. Health and safety policies, procedures and keeping equipment in good order helped protect the health and welfare of staff and people who used the service. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 9 of 27 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 27 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The good assessment process ensured each persons assessed needs could be met at the care service. Evidence: Four plans of care were examined during the inspection. Two plans of care from Rowan and one each from the other two units were examined to gain a balanced view of how the service was performing. An assessment had been undertaken by an experienced member of staff to ensure they were suitably placed. Social services or the local hospital trust had supplied the care home with information. The information was then used to help formulate a plan for staff to deliver care. This care service did not provide intermediate care. Care Homes for Older People Page 12 of 27 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The excellent plans of care demonstrated how each person was regularly assessed to help staff meet their needs. People who used the service had access to specialists to keep their health care up to date. In general the administration of medication was safe for people who used the service. People who used the service were treated privately to help maintain their dignity. Evidence: Four plans of care were examined during the case tracking process to ensure they gave staff information about the needs of people who used the service. The plans of care contained excellent details for staff to deliver effective care and had been updated on a regular basis to keep each persons records accurate. The plans had been developed, where possible, with the assistance of a family member or person who used the service to take account of their wishes. A risk assessment had been undertaken for tissue viability, falls and nutritional needs to help keep people safe. Care Homes for Older People Page 13 of 27 Evidence: Plans of care showed people who used the service had access to specialists or professionals such as opticians and chiropodists to help meet their needs. The registered manager said all staff who administered medication had been trained to do so safely. The medication administration charts were examined and contained gaps where medication should have been signed for. This may put people who use the service at risk. There was a safe system for storing medication including controlled drugs. Staff had access to publications to understand the effects medication had on people who used the service. Staff were observed to treat people privately during the inspection. The inspection was mainly conducted from the dining room. Staff were heard talking to people who used the service in a polite manner, which helped them feel comfortable with their care. Care Homes for Older People Page 14 of 27 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who used the service were offered suitable activities to help keep them stimulated. Visiting was unrestricted to encourage people who used the service to socialise with family and friends. People who used the service were offered good choices within the routines of the home for their contentment. The food served at the home met people nutritional needs. Evidence: There was a list of activities people could attend if they wished. Outside agencies were used to provide entertainment such as bingo to keep people who used the service occupied. On the day of the inspection people were observed playing bingo, dominoes or watching television and appeared satisfied with the activities they engaged in. One visitor confirmed staff were welcoming and visiting was unrestricted to help people keep in touch with their families. Details of the choices offered to people who used the service was well documented within the plans of care. Choice was offered for food, personal care, religion, or the right to attend activities or not. People were offered choice to help retain their independence.
Care Homes for Older People Page 15 of 27 Evidence: The meal served on the day of the inspection was hot, nutritious and appealing. People who used the service said the meal was good. The meal was served in an unhurried way and any person who required feeding was treated individually and with dignity. The cook said the views of people who used the service helped formulate the menu. Environmental health checks were undertaken by the cook to help keep people safe. People were given a choice of two options at mealtimes but the cook said an alternative was offered if required to ensure the meal was enjoyed. The dining room was set attractively for the enjoyment of people who used the service. Care Homes for Older People Page 16 of 27 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a good complaints procedure which allowed people who used the service to voice their concerns. Robust adult abuse procedures and a good reporting ethic helped protect people who used the service from harm. Evidence: There was a complaints procedure which contained the relevant timescales and contact details of the Care Quality Commission (CQC). The complaints procedure was accessible for people who used the service. There had been one complaint made to the CQC since the last key inspection. The prompt and efficient way the care service responded showed they took complaints seriously. There have been seven allegations of abuse since the last key inspection. The service have handled the allegations transparently and have taken management decisions which should ensure the numbers are reduced. There are safeguarding policies and procedures for staff to follow good practice. The home use the Blackburn with Darwen procedures to follow a local initiative. Staff are being trained in safeguarding issues to help protect people who use the service. Some staff have also undertaken training in challenging behaviour to better manager difficult situations. There was a copy of the No Secrets document and a whistle blowing policy to give staff further guidance. Care Homes for Older People Page 17 of 27 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care home was warm, clean and fresh smelling to provide a homely atmosphere for people who used the service. The services and facilities met the needs of people who used the service. Evidence: A tour of the building was conducted on the day of the inspection to check the services and facilities of the care home. The home was clean, warm and odour free demonstrating that a better system of cleaning was found than at two previous inspections. An attempt had been made to spruce up some areas of the home that needed decorating and this should continue to provide more pleasant surroundings for people who use the service. The communal areas contained sufficient domestic type furniture to seat people in comfort. Communal areas were bright and provided a place for people to socialise. There was an attractive garden area which had good access for the disabled and could be used by everybody, weather permitting. Bedrooms visited had been personalised to each persons taste to be familiar to people
Care Homes for Older People Page 18 of 27 Evidence: who used the service. There was a lock for privacy and people could retain a key if able. Bedrooms contained good levels of furniture for peoples comfort. Hot water outlets and radiators has suitable controllong devices to prevent scalding and windows did not pose any accident risks to people who used the service. There was a ramp, grab rails, mobility equipment and hoist to help with the mobility of people who used the service. There was a laundry which was well equipped to clean people who used the services clothes. There was an infection control policy and procedures for staff to follow good practice. Care Homes for Older People Page 19 of 27 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were sufficient numbers of well trained staff on duty to meet the needs of people who used the service. The robust recruitment procedures protected people from possible abuse. New staff received a good induction to help them meet the needs of people who used the service. Evidence: The staffing on Rowan ward had been improved since the last key inspection. This was verified by managers and staff who said it was much better for them and people who used the service. The person in charge said this was now the normal amount of staff and felt they were meeting the needs of people on the unit. There were sufficient domiciliary staff to provide good food and keep the home clean. Two staff files were examined during the inspection and demonstrated there was a good selection and recruitment procedure. Staff files contained evidence prospective staff had been police checked, references obtained and their history scrutinised to ensure they were safe to employ. 50 of staff had completed NVQ2 training or better. Two staff files contained training certificates and staff confirmed training had been undertaken in moving and handling, fire awareness, food hygiene, first aid, safeguarding health and safety and dementia. Further training was planned to further strengthen the staff team. Files contained
Care Homes for Older People Page 20 of 27 Evidence: evidence that new staff had a comprehensive induction period to familiarise themselves with the home and the people who lived there. Care Homes for Older People Page 21 of 27 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered person must ensure that a suitably qualified and experienced person is registered with the Care Quality Commission to meet current legislation. Quality assurance systems needed some improvement to fully demonstrate how the care service reacted to the views of significant others. The good system used for handling money helped protect the people who used the service from financial abuse. Good health and safety systems helped protect the health and welfare of staff and people who used the service. Evidence: The home had undergone management changes since the last key inspection. The proposed manager was present for the inspection as was the new unit manager on Rowan. An application to register the manager had been submitted and should be completed as soon as possible to meet CQC requirements.The new management structure were just settling in but their ideas and drive gave a feeling of confidence for the future. Care Homes for Older People Page 22 of 27 Evidence: The manager held formal recorded meetings with staff and people who used the service to gain and respond to their views. She also held management meetings to drive improvements forward. The manager said she would be conducting a survey on the quality of service in the near future and would produce a summary management could respond to. A good quality monthly audit of the services and facilities helped highlight any problem areas which could then be attended to. There was a compuiterised system for handling pocket money. Two staff would sign for transactions and receipts obtained. The system was regularly audited to check for any errors or discrepancies. There were health and safety policies and procedures for staff to follow good practice. Most staff had attended mandatory health and safety training to help keep people safe. The certification for electrical or gas equipment and installation was up to date. All other equipment such as the fire alarm system was maintained to help keep people safe. Staff had been issued with a handbook which gave good advice on how to follow safe practices. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 9 The registered person should ensure the medication records are accurate. Where a medication has been omitted or refused this must be recorded in the chart. The registered person should ensure two staff sign for the disposal of medication to prevent errors or drug misuse. The registered person should try to access external safeguarding training to help staff understand local protection of adults issues. The registered person should devise a better system for attending to damaged walls or other areas in need for decoration to provide a more pleasant atmosphere for people who use the service. The registered person should improve the training matrix to provide a simpler way for her to check what training staff had undertaken, what training they needed to do and when it should be updated The registered person should ensure the application to register the proposed manager is completed as soon as possible to meet current legislation. 2 3 9 18 4 19 5 30 6 31 Care Homes for Older People Page 25 of 27 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 7 33 The registered person should ensure that the new manager, when settled, sends out survey forms to people who use the service and produce a summary to demonstrate a responsive service. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!
