Inspection on 30/03/09 for The Boltons

This inspection was carried out on 30th March 2009.

CSCI found this care home to be providing an Good service.

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

The Boltons 02/11/06

The Boltons 15/12/05

The Boltons 17/06/05

The Boltons 18/01/05

The Boltons 03/08/04

The Boltons 19/03/04

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Boltons 4 College Road Reading Berkshire RG6 1QB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Willis     Date: 3 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: The Boltons 4 College Road Reading Berkshire RG6 1QB 01189261712 01189261712 vjuggurnauth@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Vijaye Juggurnauth,Mrs Premila Juggurnauth care home 18 Number of places (if applicable): Under 65 Over 65 0 18 mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 18 0 The maximum number of service users to be accommodated is 18 The registered person may provide the following category of service: Care home only (PC) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category: Old age not falling within any other category (OP) Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home The Boltons is a small residential care home for older people situated in a residential area close to Palmer Park in Reading. The Registered manager has owned and managed the home for the last 18 years. The age and design of the Victorian building make it unsuitable for residents with mobility restrictions, despite the lift to the first floor. An extension has been added which has given a number of rooms large en-suite bathrooms. There is one shared room within the home. The home provides care for Care Homes for Older People Page 4 of 27 Brief description of the care home service users with a range of multi-cultural needs. Fees vary from 410 - 530 pounds per week. 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 inspection took place on a weekday morning and afternoon over the course of six and half hours. It was carried out by Julie Willis - Regulatory Inspector and Penny Wright - Expert by Experience. It was a thorough look at how well the service was doing. It took into account detailed information provided by the services manager and any information that CSCI has received since the last inspection which took place on 2nd November 2006. Prior to the visit a questionnaire was sent to the home along with survey and comment cards for residents, carers, staff and visiting professionals. Any replies were used to form judgments about the service. Consideration has also been given to other information that has been provided to the Commission since the last inspection. Care Homes for Older People Page 6 of 27 The inspectors toured the building, examined records and met all of the residents. The inspectors also spent time talking informally to staff and management and observing how care was being delivered to residents. From the evidence seen and comments received the inspector considers this service has a good awareness and understanding of equality and diversity issues and would be able to provide positive outcomes for people in the areas of race, ethnicity, age, gender, sexuality, disability and belief. The inspector gave feedback about her findings to the management at the end of inspection. There were no legal requirements made as a result of this inspection. The Commission has received no information about complaints since the last inspection. What the care home does well: 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 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 9 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. People are fully assessed before admission to ensure their needs can be met effectively by the home Evidence: The pre-admission assessment for three residents was examined. There was evidence that all necessary information about the prospective residents health and personal care needs are sought prior to admission, along with information about their dietary needs, communication needs, mobility needs, history of falls, continence, medication regime and mental state. Information is gathered from a variety of sources, including the prospective resident, their family and other health and social care professionals. The information gathered is used to produce an initial care plan and to ensure that any aids or equipment needed by the resident are available on admission. Care Homes for Older People Page 10 of 27 Evidence: Results of seven CSCI surveys confirmed that residents have the information they need to decide if the home is right for them. Residents confirmed that they had been provided with an opportunity to visit the home informally where they met staff and other residents and had the opportunity to ask questions of the management. They also confirmed that they had been offered a trial period before committing to stay at the home indefinitely. Care Homes for Older People Page 11 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. Clear information is in place to enable staff to effectively meet the health and personal care needs of residents. Residents are encouraged to participate in the care planning and review process from the outset. Residents are provided with quality care in a manner, which maintains their right to dignity, privacy, independence and choice. The system for the administration of medication is good with clear and comprehensive arrangements in place to ensure the safety of residents. Evidence: The inspectors spoke at length to eight of the residents and one relative that was visiting at the time of inspection. The residents were complimentary about the quality of care they were receiving they seemed happy and content. One resident told the inspector that they had been lonely in their council accommodation and was very much enjoying living at the home. It was evident that many of the residents had been living at the home for a long period of time between two and five years. Although most of the residents were local to Reading several people were from Poland, one person was Care Homes for Older People Page 12 of 27 Evidence: from the Chinese community and two people were from the Caribbean. The home prides itself on being multi-cultural and able to meet the needs of people from a diverse range of backgrounds. Staff are employed that can converse with residents in their first language as well as English. The files of three residents were examined and the residents were case-tracked from their pre-admission assessment to date. The written records were detailed, comprehensive and holistic. They provided staff with the information they needed to provide the right care. It is clear that the emphasis in the home is on maintaining residents skills and independence as sufficient time is given for staff to oversee self care. The home has an efficient review system in place. All care plans are reviewed monthly and any changes to the care plan are well documented. Risk assessments had been undertaken on manual handling, risk of falls and bathing. In the case of one resident there was a risk assessment in place for challenging behaviors. Where a risk had been identified there were risk reduction measures in place. Observation of care practice concluded that residents are encouraged to remain as independent as possible by providing appropriate levels of support to maintain the residents privacy, dignity, choice and independence. Staff were observed to provide personal care in a discreet and sensitive manner and were heard to be polite and courteous at all times. Staff routinely knocked on bedroom doors and waited until invited in. Residents confirmed in CSCI surveys that they were provided with access to health and social care professionals when required. The inspectors had the opportunity to meet one of the General Practitioners from the local surgery who was visiting at the time of inspection. They confirmed that the quality of care was good at the home and that the management consulted the doctors and nurses at the surgery for advice and support when needed. The doctor confirmed that residents were offered routine screening and preventative treatments as required. There was also evidence on file that residents regularly have chiropody treatments and attention to their vision and hearing. Feedback from surveys provided by the CSCI to health professionals involved with the home confirmed that the home is well respected and provides a good standard of care. Quotes taken from the surveys said, the staff follow instructions and are eager to be Care Homes for Older People Page 13 of 27 Evidence: involved in caring episodes, the staff respect the diverse needs of residents and the staff are able to act upon signs of deterioration in their residents they respond appropriately to instruction and requests from GPs or nursing staff. From examination of the medication system and discussion with management it is clear that the home follows best practice guidance in relation to the storage, administration and disposal of drugs. Staff have been trained in the administration of medication and are certificated. A monitored dosage system is in operation at the home and medication is delivered to the home on a monthly basis. Storage systems are effective and disposal systems are safe. 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 are provided with the opportunity to participate in a range of leisure activities, trips out and entertainments suited to their needs. The meals in the home are good and offer residents choice and variety. Special diets can be catered for effectively. Evidence: From discussion with management, staff and residents it is clear that residents are offered the opportunity to participate in a range of activities suited to their needs. The homes management organises the activity schedule and has undertaken training in reminiscence therapy. The activity schedule is varied and includes trips to local shops, walks, gentle exercise, painting, dancing, Bingo, card games, massages and manicures. In addition the Manager receives Memory box materials from the local library which is used to prompt reminiscence. Each month a company called Motivation visit the home to carry out creative and meaningful activities with the residents. Records of their visits are detailed in the activity portfolio. In addition there is fortnightly live entertainment from a visiting Care Homes for Older People Page 15 of 27 Evidence: musician. Most of the residents spend their day in the lounge with only one or two residents electing to spend time in their bedrooms. One resident goes out weekly to the Do it Club in Theale. The resident said that they particularly enjoyed their trips out. Another resident is taken to the bank and to local shops by the homes management on a regular basis. On the day of inspection music was playing in the lounge during the morning and there were plans for residents to watch ice skating in the afternoon. The menu at the home is varied and nutritious. The lunch time menu was sampled by inspectors and was well cooked and tasty. Residents are provided with a choice of meals that meets their cultural needs. One resident cooks their own Chinese food in the kitchen supported by the staff and two residents have Caribbean food provided as an alternative to the main meal. Responses to CSCI surveys said, the food is good, tasty meals and always plenty. 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. The home has a satisfactory complaints system. Residents feel their views are listened to and acted upon. Residents are protected from abuse and exploitation by trained and knowledgeable staff. Evidence: The complaint policy in the home meets the requirement of Regulation and Standard. Residents are provided with information on how to make a complaint and the stages and time scales for action. The complaints procedure is written in plain English and is easy to understand. Consideration should be given to translating the complaint policy into other languages to meet the needs of residents whose first language is not English. Examination of the complaint records evidenced that there have been no complaints made to the home since 18th August 2008. Details of previous complaints were well documented and evidenced investigation undertaken and outcome to the complainant. The CSCI has received no information about complaints about the home since the last inspection. Responses to CSCI surveys confirmed that residents felt confident that any concerns Care Homes for Older People Page 17 of 27 Evidence: or complaints would be taken seriously by the home and efforts would be made to remedy any problems in a timely fashion. There was evidence in staff files and from discussion with staff and management that they receive training in safeguarding adults as part of their formal induction to the home. The learning is later consolidated when undertaking National Vocational Qualifications in which it forms a core module. Staff are aware of their responsibilities in relation to whistle-blowing. Residents said they felt satisfied with the service and felt well cared for and safe. Care Homes for Older People Page 18 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 home is satisfactorily maintained and provides people with a comfortable place to live. Evidence: The home is an old Victorian building with many flights of stairs between floors and different areas of the home. It is not entirely suitable for people with mobility difficulties although there is a lift to the first and second floors and wheelchair access to the rear. In general the home is satisfactorily maintained although some carpeting and decor is tired and needs renewal. This is not subject to requirement because the management of the home told inspectors that there are plans to convert the house next door into an extension of the home. Plans have been passed and the home is awaiting the start of major renovations. The laundry is sited opposite the office in the basement. It was clean and satisfactorily organised. There is no designated laundry person, instead staff do the laundry as part of their normal duties. The home has undergone some refurbishment in the past year. En-suite facilities have Care Homes for Older People Page 19 of 27 Evidence: been added to five bedrooms and four more are yet to be completed. Residents spend most of their day in the lounge. There is a patio to the rear which overlooks the garden. The gardens are used during the clement weather. Care Homes for Older People Page 20 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. Recruitment procedures at this home are robust and transparent and ensure resident safety. Staff are well trained and knowledgeable. Evidence: Examination of two staff files evidenced that the selection and recruitment procedures at this home are robust. All necessary checks are carried out on staff to ensure that they possess the necessary attributes to care effectively for the residents. Records were well kept and met the required standard. All new staff have a full induction to Skills to Care standard within their first six weeks of employment. Core skills training is encompassed in the induction training. The home has a comprehensive training plan which links to the staffs individual personal development plans. Most of the training is accessed via the Local Authorities training department who offer courses in care of medicines, DOLs (Deprivation of Liberty), communication skills, first aid, food safety, health & safety, managing challenging behavior in dementia, meaningful activities for people with dementia, manual handling, continence issues, safeguarding levels 1,2 & 3, understanding and managing dementia, supporting peoples personal care needs and introduction to E learning. Care Homes for Older People Page 21 of 27 Evidence: Staff are also offered the opportunity to attain National Vocational Qualifications at levels 2 & 3 to further enhance their knowledge and skills. Over 95 of the current staff have already achieved these qualifications. Residents confirm that staff are caring and kind. Comments received in CSCI surveys said, the staff are lovely here, ever so helpful and the staff try their hardest, they are always very kind. Care Homes for Older People Page 22 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. Residents benefit from living in a well managed home, where their health and safety are of primary importance. The Registered persons are qualified, competent and experienced to run the home for the benefit of residents. Evidence: The Registered Manager - Vijaye Juggurnauth is competent and experienced. He is a qualified mental health nurse who has attained the Registered Managers Award to further enhance his knowledge and skills. He is supported in his work role by his wife Premila Juggurnauth who has attained an NVQ level 4 and Registered Managers Award. They work at the home daily in a hands-on capacity and regularly sleep-in, on call, in case of emergencies. The response to CSCI surveys confirm that residents think that management are Care Homes for Older People Page 23 of 27 Evidence: caring, kind and responsive. They say that there is an open and inclusive atmosphere in the home. There are regular residents meetings which ask residents opinions on issues that affect them. Residents feel that their views are listened to and taken into account. From examination of the minutes of residents meetings there was evidence that when requests are made or concerns expressed in the meetings the issues are followed up promptly by management. The home undertakes regular quality audits. Customer satisfaction surveys are provided to all stakeholders and responses are collated and used by management to identify where improvements can be made to services. Residents are regularly consulted about their care needs as part of the formal review process. They can ask to see their records at any time and will be given access. All records required by Regulation were found to be well maintained secure and up-todate.All staff are aware of the need to treat information confidentially and to maintain records securely in accordance with the Data Protection Act 1998 and other statutory requirements. A number of health and safety records relating to fire safety and the maintenance of the hot water system were sampled and found to be accurately documented and upto-date. Advice was given about recording the actual temperature of the hot water instead of ticking that it is OK in the records. Routine servicing and maintenance of equipment is carried out in accordance with the requirements of legislation and good practice guidance. Activities that pose a risk to residents are fully assessed and procedures are put in place to reduce the risk of occurrence. Care Homes for Older People Page 24 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 25 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 Care Homes for Older People Page 26 of 27 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI 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!