Care Home: Boarbank Hall Nursing Home

Similar services:

• Chirnside House
• Keer Sands Residential Home
• Ruskin Lodge
• Bushell House
• Langrigg House
• Parkside
• Dystlegh Grange
• Thornton Lodge

What the care home does well Boarbank Hall Nursing Home provides a comfortable and homely environment for the people who live there, it is comfortably furnished and the atmosphere is relaxed and calm. Many people use the home for respite care and return many, times year after year and some then choose to become permanent residents when they feel they need to. Admissions to the home are managed sensitively with the emphasis on supporting people and providing a homely atmosphere. The staff also provide accessible information for people thinking of coming to live there to help them make a decision. The home is being well maintained, with a maintenance programme and safety testing to keep people safe. The gardens are very attractive, tidy and accessible to people living there and some of the home`s vegetables are grown there. The manager and staff try to make sure that there are plenty of opportunities for people to be involved in activities in the home and people may follow their own interests or join in organised events in the home. People are well supported to follow their own faiths and culture and follow interests that have meaning for them within their local community. The bedrooms in the home are, with one exception, single occupancy and people can bring in their own things to make their rooms more personal. The lounges and dining areas are warm and welcoming and furnished with suitable chairs for different needs and seats are arranged in informal groups. The service has good systems in place for recruitment and training and this helps make sure that people are supported by the right staff who understand their needs. The staff group is a stable and experienced one and strive to deliver person centered care to a high standard. Staff working there reported a high standard of job satisfaction and having time to spend supporting the people living there in a holistic way. The management team have systems for monitoring the home`s performance and getting people`s opinions on the home through consultation with the people living there and the staff working there. This helps to make sure they are meeting people`s expectations and helps show if they need to improve any aspects of the service to make it better or safer for people. There are effective complaints and safeguarding systems for the people living there, and for staff, to help make sure that concerns and complaints are taken seriously, investigated and action taken. People living there expressed confidence in the manager to deal with any concerns they might raise. The home has a competent management team that display a clear focus on maintaining high standards of care in the home and on supporting staff in professional development to improve the care they give. The home also maintains good working relationships with local doctors and specialist nursing services. The manager keeps CQC informed of any changes or incidents in the home and responds positively to the inspection process and any advice given. There is a very high standard of catering in the home and menus show choice and availability of nutritious food , prepared by the home`s cooks. People living there are able to exercise considerable choice and flexibility in their choice of food. The home is clean, fresh and tidy and kept free from clutter. Great care is taken to ensure small details are observed that make it seem more homely such as fresh flowers around the home. People made many positive comments about the home, including, This is a very special place, I feel safe and cared for, it is quite perfect". " The input from the sisters is paramount to the atmosphere of love and time for everyone". "They do everything well, I can think of nothing but good things". "So attentive and understanding". " Boarbank Hall is exceptionally good in all respects that I have encountered during my stay". What has improved since the last inspection? Since the last inspection work has been done on updating the Statement of Purpose and information for people, including an updated brochure for more information. A `welcome` leaflet for all new people living there is currently being developed to help them as they settle in. Since the last inspection the manager has begun working to increase and give greater range to the activities programme in the way people living there have said they want, such as trips out. Also as a result of what people living there have said they want the range of items sold at the shop has now been increased to provide more items. As part of developing the care plans in a person focused way the staff have implemented `Preferred priorities of care` to establish individual preferences for care at the end of life and a person`s wishes in this respect. This has also included families discussing care in conjunction with people`s doctors to make sure people are clear about their priorities at the end of life. The home has a maintenance programme of upkeep and refurbishment and re decoration continues externally and internally with the replacement of bedroom carpets and decoration of the main corridors. Changes are also planned to be made to the small laundry used for personal clothing. It will have separate `clean` and `dirty` areas to help improve infection control and reduce the risk of any cross infection. Some important areas of staff training have been improved including training on recognising and preventing abuse and access to external trainers has also been improved and opportunities for this increased. A much more organised and formal system has been put in place to make sure staff receive formal supervision and feedback on their performance. Also one of the nursing staff has been working towards achieving her mentorship status and another undertaken training to provide exercise sessions for people living there. What the care home could do better: Boarbank has its own procedures in place for monitoring and improving practices. The manager acts on areas identified as needing improvement or change. The manager has already identified the need for more opportunities for more physically frail people to use the minibus and is taking steps to address this. They have also identified the need for infection control training to be provided for all staff. We strongly recommended that they did so quickly. We have found that the management team welcome suggestions that will help them improve their service to benefit the people living there and work well with other agencies to try to do this. We did not make any requirements at this inspection. Key inspection report Care homes for older people Name: Address: Boarbank Hall Nursing Home Boarbank Hall Nursing Home Allithwaite Grange Over Sands Cumbria LA11 7NH     The quality rating for this care home is:   three star excellent 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: Marian Whittam     Date: 1 2 0 4 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 32 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 32 Information about the care home Name of care home: Address: Boarbank Hall Nursing Home Boarbank Hall Nursing Home Allithwaite Grange Over Sands Cumbria LA11 7NH 01539532288 01539532288 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Canonesses of Saint Augustine Name of registered manager (if applicable) Sister Eileen Anne Pollard Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 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 (maximum places: 4) The maximum number of service users who can be accommodated is: 27 Date of last inspection Brief description of the care home Boarbank Hall Nursing Home is owned and managed by the Augustinian Canonesses of the Mercy of Jesus, a Catholic Religious Order dedicated to caring for others. They provide long term and respite care for up to 27 residents including terminal care and convalescent/post operative nursing care. Care Homes for Older People Page 4 of 32 0 4 Over 65 27 0 Brief description of the care home Boarbank is located at the edge the Lakeland village of Allithwaite, facing south and overlooking Humphrey Head and Morecambe Bay. The home is a short distance from the village of Allithwaite and its amenities, such as the public house, bus routes into Grange and the local post office and shop. Alongside the nursing home is the Sisters own religious community, a guest -house and a Chapel. Relatives and carers can stay in the communitys guest- house and use their amenities. Accommodation in the home is on two floors and there are two passenger lifts and the home has a fully equipped physiotherapy suite on site. The home has large gardens with a terraced area that is accessible to wheelchair users and has a childrens play area in the grounds. The home also has its own kitchen gardens and grows some of its own vegetables for use in the home. There is ample car parking space at the rear and side of the home. The fees charged by the home range from 570 pounds per week up to 580 pounds per week for an en suite room, as at the date of the inspection. Information about the home, its facilities and the range of services on offer are found in the Statement of Purpose and service user guide and brochure which are available in the home. Copies of previous reports are also available for people to read. An additional charge is made for a private telephone, personal toiletries, newspapers, magazines, hairdressing, and chiropody. There is also a small charge for personal laundry. Care Homes for Older People Page 5 of 32 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: three star excellent 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: The quality rating for this service is 3 star. This means that the people who use this service experience Excellent quality outcomes. This site visit to Boarbank Hall Nursing home forms part of a key inspection. It took place on 12.04.2010 and we were in the home for seven hours. Information about the service was gathered in different ways: 1. We (CQC) sent out an Annual Quality assurance Assessment (AQAA) to the home for the registered manager to complete and return to us. The AQAA is a self assessment and a dataset that is completed annually by all providers of registered services. It is one of the ways we gather information from the providers about their service and how they believe they are meeting outcomes for the people living there and using their service. The AQAA also gives us statistical information about the individual service and trends and patterns in social care. Care Homes for Older People Page 6 of 32 2. We sent out surveys to people living in the home to complete to get their views on the home and the service they received. We also sent out surveys to staff working there so we could get their views on working there and the training and support they received. 3. We looked at all the information we have about the service, any changes they have made and how the management has dealt with any complaints or the safeguarding of vulnerable adults. We looked at what the management has told us about things that happened in the service, these are called notifications, and are a legal requirement. We looked at the previous key inspection and any calls or visits we have made to the home since their last inspection. 4. We spent time during our visit talking to people who live at Boarbank and spent time with them throughout the day. This helps us to see what happens during their day and ask people what they think about the way the home is run for them. We also spent time talking with visitors to the home and to staff who work there to get their views. 5. We looked at any relevant information we had received from other agencies and organisations and any written comments or concerns people have made to us. During the day we spent time talking with people while they were in communal areas and also in private in their rooms. We looked at care planning documents and assessments to make sure that people received the level of care they needed and expected. We made a tour of the premises to look at the environment people lived in, how it was being maintained for people and what facilities and choices were available to them. We also looked at staff training and recruitment files and a sample of records and safety assessments required by regulation. We also assessed the handling of medicines through the inspection of relevant documents, storage systems and meeting with the manager and staff. Feedback was given to the care manager at the end of the visit. Care Homes for Older People Page 7 of 32 What the care home does well: Boarbank Hall Nursing Home provides a comfortable and homely environment for the people who live there, it is comfortably furnished and the atmosphere is relaxed and calm. Many people use the home for respite care and return many, times year after year and some then choose to become permanent residents when they feel they need to. Admissions to the home are managed sensitively with the emphasis on supporting people and providing a homely atmosphere. The staff also provide accessible information for people thinking of coming to live there to help them make a decision. The home is being well maintained, with a maintenance programme and safety testing to keep people safe. The gardens are very attractive, tidy and accessible to people living there and some of the homes vegetables are grown there. The manager and staff try to make sure that there are plenty of opportunities for people to be involved in activities in the home and people may follow their own interests or join in organised events in the home. People are well supported to follow their own faiths and culture and follow interests that have meaning for them within their local community. The bedrooms in the home are, with one exception, single occupancy and people can bring in their own things to make their rooms more personal. The lounges and dining areas are warm and welcoming and furnished with suitable chairs for different needs and seats are arranged in informal groups. The service has good systems in place for recruitment and training and this helps make sure that people are supported by the right staff who understand their needs. The staff group is a stable and experienced one and strive to deliver person centered care to a high standard. Staff working there reported a high standard of job satisfaction and having time to spend supporting the people living there in a holistic way. The management team have systems for monitoring the homes performance and getting peoples opinions on the home through consultation with the people living there and the staff working there. This helps to make sure they are meeting peoples expectations and helps show if they need to improve any aspects of the service to make it better or safer for people. There are effective complaints and safeguarding systems for the people living there, and for staff, to help make sure that concerns and complaints are taken seriously, investigated and action taken. People living there expressed confidence in the manager to deal with any concerns they might raise. The home has a competent management team that display a clear focus on maintaining high standards of care in the home and on supporting staff in professional development to improve the care they give. The home also maintains good working relationships with local doctors and specialist nursing services. The manager keeps CQC informed of any changes or incidents in the home and responds positively to the inspection process and any advice given. There is a very high standard of catering in the home and menus show choice and availability of nutritious food , prepared by the homes cooks. People living there are able to exercise considerable choice and flexibility in their choice of food. The home is Care Homes for Older People Page 8 of 32 clean, fresh and tidy and kept free from clutter. Great care is taken to ensure small details are observed that make it seem more homely such as fresh flowers around the home. People made many positive comments about the home, including, This is a very special place, I feel safe and cared for, it is quite perfect. The input from the sisters is paramount to the atmosphere of love and time for everyone. They do everything well, I can think of nothing but good things. So attentive and understanding. Boarbank Hall is exceptionally good in all respects that I have encountered during my stay. What has improved since the last inspection? Since the last inspection work has been done on updating the Statement of Purpose and information for people, including an updated brochure for more information. A welcome leaflet for all new people living there is currently being developed to help them as they settle in. Since the last inspection the manager has begun working to increase and give greater range to the activities programme in the way people living there have said they want, such as trips out. Also as a result of what people living there have said they want the range of items sold at the shop has now been increased to provide more items. As part of developing the care plans in a person focused way the staff have implemented Preferred priorities of care to establish individual preferences for care at the end of life and a persons wishes in this respect. This has also included families discussing care in conjunction with peoples doctors to make sure people are clear about their priorities at the end of life. The home has a maintenance programme of upkeep and refurbishment and re decoration continues externally and internally with the replacement of bedroom carpets and decoration of the main corridors. Changes are also planned to be made to the small laundry used for personal clothing. It will have separate clean and dirty areas to help improve infection control and reduce the risk of any cross infection. Some important areas of staff training have been improved including training on recognising and preventing abuse and access to external trainers has also been improved and opportunities for this increased. A much more organised and formal system has been put in place to make sure staff receive formal supervision and feedback on their performance. Also one of the nursing staff has been working towards achieving her mentorship status and another undertaken training to provide exercise sessions for people living there. Care Homes for Older People Page 9 of 32 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. 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 32 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 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People coming to live at Boarbank are given information about the home and experience what they see as a sensitive and individualised admission process but the completion of detailed pre admission assessments is not always consistent, which may undermine the personalised process. Evidence: Clear information about the home and the services provided is available in the Statement of Purpose and Service User Guide that is given to all people living in the home and people asking about using the service. There is also a web site and a colour brochure with pictures of the home inside and the grounds to give people an idea of what to expect. The documents have been subject to regular review to make sure the information is up to date. Copies of previous inspection reports are also available for people to look at if they wish. A welcome pack is also currently being developed for everyone to have in their bedrooms with general information on the service to help people settle into their new home. This level of information helps to make sure that Care Homes for Older People Page 12 of 32 Evidence: people thinking of coming to live there and their families know what the home can provide to meet their needs and helps them make an informed decision. Before people are offered a place at Boarbank the registered manager and senior staff gather information from the person themselves by using a self assessment questionnaire and from other agencies and health care professionals involved in their care and any treatment. Where appropriate a care management plan is obtained from social services if they are making the referral. The manager and staff have close working links with local GPs. They have developed some informal systems around admissions and as a result some pre admission information lacks detail and so do not give comprehensive information to begin to form a care plan and make sure all needs can be met. These kind of informal arrangement are not well evidenced so people cannot be assured of a robust assessment before being offered a place and so be assured their needs will be met as they need and expect. We discussed with the care manager the importance of making sure that a thorough pre admission assessment is always done, by staff qualified to do so, with people without a care management plan. This assessment needs to be detailed and include all relevant areas of needs assessment set out in the National Minimum Standards. We could see in peoples care plans where social workers, therapists and medical consultants had been involved in assessing people after admission and assessments by nursing staff on admission were clear and detailed. There was no evidence to suggest that outcomes for people who had been recently admitted were anything other than good, despite the informal approaches in some care plans we looked at in detail. From speaking with people using the service we found that they felt admissions to the home were managed sensitively with the emphasis on supporting them and providing a homely atmosphere. We received many positive comments from people, including; This is a very special place, I feel safe and cared for, it is quite perfect. I felt at home here as soon as I arrived, staff were attentive and knew what to do and seem really interested. I wish I had come here for respite before. It is the policy at Boarbank that admissions are always considered with regard to the current workload of staff and the needs and dependency of people already living there. This practice is to help make sure that the existing good nurse/carer ratio to people living there is not compromised. One person living there told us, Patients are particularly helped by the kindness of the staff as well as their outstanding efficiency. Surveys we received from people living there indicated they had information before they moved in, to help them decide and that they felt they always received the care Care Homes for Older People Page 13 of 32 Evidence: and support they needed. There is a trial period when people first come into the home to make sure it suits them and that their needs are being fully met. There is also a review as part of this process with the person and those involved in their care and support. Admissions to the home are managed sensitively with the emphasis on supporting people and providing a homely atmosphere. Some people we talked with had used the home before for respite care and so had been introduced to the service that way and got to know the staff. We spoke to a person who was having respite care and they were pleased with the admission process and felt they had been given all the information needed to decide about using the home and about their care. They told us, I cannot praise the staff and my care highly enough, the nurses are very knowledgeable and I feel safe and more confident. The home does not provide intermediate care. Care Homes for Older People Page 14 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear care planning records are in place and a safe system of medication handling helps make sure peoples individual health, personal and social care needs are met as they want and prefer following admission. Evidence: The service has individual care plans for people living there based on initial needs assessments and risk assessments. We looked at four care plans in detail and talked with the people using the service and the staff to assess if peoples health, personal and social care needs were being met as that needed and expected. The care plans set out clearly peoples individual health, personal and social care needs and these had been reviewed. Relevant risk assessments were in place including pressure areas, nutrition, mobility and moving and handling. The plans had management plans for specific conditions, following surgery and wound care. Appropriate equipment to prevent pressure sores is in use. We found that nutritional screening and monitoring of weights required in the care plan was being consistently done. There was also useful personal information to draw upon in an individual profile. This information helps staff be aware of individual expectations and personal preferences. Evaluation Care Homes for Older People Page 15 of 32 Evidence: and development of the care plans is ongoing to continue to make them more focused upon the individual and how they want to be supported. The nursing staff review the care plans monthly and update care needs. We could see that wound care was well managed and reviewed daily and levels of pain and discomfort monitored and reviewed frequently to make prompt changes if needed. All the surveys we received back from people living at Boarbank said that the home always made sure they got the medical care they needed. Referrals to doctors and other health care and specialised services are in care plans and records are kept of what is to be done and monitoring. Doctors from local surgeries visit and review peoples medical needs with nursing staff. We received comments from people living at Boarbank and their relatives in our surveys and we asked people about their care and the support they received from staff. People made many positive comments about the staff and their care, including, They look after my aunt very well. The staff are so attentive and helpful, constantly monitoring your condition. Its wonderful, the staff know what to do and the nurses are very knowledgeable. Time is no object to them, there is always someone about, always in and out to see me. I keep my own medicines and the nurses have explained everything to me. From what we saw of positive staff interaction during the day, our survey responses and what people told us about living there the indication was that people felt well cared for and supported by staff. Staff were seen to spend a lot of time with people chatting, supporting and reassuring them where needed. We examined the handling of medication by looking at relevant documents, storage and speaking with the nursing staff. We looked at records for receipt and administration of medication. We counted a sample of medicines and compared these with records to check if they tallied and to show they were administered in the prescribed dosage. These samples were in order. People are supported to manage their own medicines and maintain their independence in this aspect of their life. This is after a risk assessment has been done with them and people we spoke to who handled their own medicines told us they had discussed it with staff and had somewhere safe Care Homes for Older People Page 16 of 32 Evidence: to keep them. Records showed the assessments were being done. Medicines liable to misuse, called Controlled Drugs, were checked and were in order. Care Homes for Older People Page 17 of 32 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 living at Boarbank are supported to make their own choices about lifestyles and to meet their social and cultural needs, retaining their independence for as long as they can. Evidence: Individuals care plans recorded peoples social and recreational interests and preferences so staff had information about peoples interests and what had meaning for them. The patient profile section of the care plans gives useful information on peoples lives and backgrounds and what they considered important. This information is useful in supporting people in making choices in their daily lives and in achieving what matters to them. We spoke to people living or staying at Boarbank Hall and looked at their records of daily activities and could see they exercised choice over what they did with their time. Survey responses also supported this. We found the home provided library facilities for people and organised activities such as musical afternoons, seasonal celebrations and chair exercises as well as individual opportunities to follow interests such as computer access. The musical events had been moved to the afternoon from the evening at the request of people living there as they said they preferred that time. Care Homes for Older People Page 18 of 32 Evidence: The home also has its own mini bus and this is used for outings, although many people told us they liked to take walks in the homes attractive gardens. We saw several people sitting out on the sheltered patio areas enjoying the sunshine and the views over the surrounding countryside. There is also a childrens play area which visiting children may use. One person told us, Boarbank is situated in a most wonderful position to see a fantastic, ever changing landscape and the views are stunning. Another person commented, A lovely garden in which to wander and I have never seen such wonderful sunrises and sunsets. The care manager discussed with us their plans to improve the range of activities available to people and having updated safety training and safety procedures for using their minibus to extend the current trips out. This is to make it safer and more available to people who are frailer and with reduced mobility. The hairdresser visits regularly and their are facilities on site for people to have physiotherapy and other therapeutic techniques, such as theBowen technique. We spoke with people in their bedrooms who were reading or watching television and some had DVD players and musical equipment so they could play and listen to what they wanted. There is a small shop that carries every day items people might need such as toothpaste, soap, bubble bath, tissues and sweets. The range of items the shop sells has been increased at the request of the people living there. The home makes good provision for the religious and cultural preferences of people, including regular Anglican communion. Local ministers of various denominations will visit when asked or arrangements can be made for people to visit their own places of worship. The home has its own Roman Catholic chaplain who is available for pastoral support or to have a chat. There are several private quiet rooms and chapels where people of any faith may go for prayer or reflection. The main chapel, used by the home and local community, has a loop system so people with hearing impairments can take part with others. One person living there told us, They meet the spiritual needs as well as the physical ones of all the patients. People told us they could come and go as they wanted and see their family and friends at any time, although the manager asks that visitors avoid meal times if they can. We saw and people told us that they could take their meals where they preferred and there was flexibility and plenty of choice around the meals provided. Meals are prepared fresh each day in the main kitchen and many of the vegetables are grown in the homes gardens and greenhouses. It is transported around the home in heated trolleys to the kitchens on each floor. Special and therapeutic diets are provided. Everyone we spoke with praised the catering and the quality of food provided. Care Homes for Older People Page 19 of 32 Evidence: Comments included, The food is lovely but I cant eat it all and Its very good food and meal times so flexible, really you can have anything you want when you want. We could see that staff were helping people where they needed it and staff checked on what people were eating and provided alternatives where people asked for different things. The positive comments and the survey responses we received indicated a high level choice and satisfaction with the food. Care Homes for Older People Page 20 of 32 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. People living at Boarbank know how to raise a complaint through an accessible complaints procedure and are confident that their concerns will be listened to and acted upon to make sure they are protected from harm. Evidence: The home has a complaints procedure and a system for logging and responding to complaints made. The procedure is in the homes Statement of Purpose and service user guide and on display within the home. People living there we talked to told us they knew how to make a complaint and the survey responses we received supported this view. They knew the procedure and where to find it but also told us they felt they could speak to the nurses and the manager at any time. When asked what they thought the home did well one person commented Everything. I have no complaints at all and another said I dont know what could be done better, everything suits me well. We talked with staff who told us they had received training on safeguarding vulnerable adults and could tell us what they needed to do if they had any concerns. Training records and programmes we looked at indicated staff were being given this training. There have not been any referrals made to safe guard peoples interests sin the last year. We saw that there are clear policies and procedures in place on safeguarding vulnerable adults There are policies and procedures for staff on whistle blowing so staff can raise any poor practice issues and know they will be supported. The service Care Homes for Older People Page 21 of 32 Evidence: has a clear policy on gifts and gratuities that people may give to staff to protect their interests. Systems are in place to safeguard peoples finances and people are supported to maintain their own finances where possible and with families and representatives. Care Homes for Older People Page 22 of 32 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. People living at Boarbank enjoy a suitably adapted, clean, homely and comfortable environment that encourages safety and independence. Evidence: Boarbank Hall is a well maintained home, it is well furnished, warm and comfortable. There is a high standard of decoration throughout the home. Repairs and maintenance are well planned and this ensures that the home remains an attractive and safe place for those living there to enjoy. The home has its own maintenance staff on site for day to day maintenance and safety testing. They maintain clear records of work done, safety checks , water temperature testing, emergency lighting, call systems, which were available for inspection. All areas of the home used by people living there have accessible call bells for them to summon assistance if they want it. Outside the gardens were well kept and tidy and had appropriate seating for people living there to use. There is ample communal space for people to use and these are all accessible by passenger lift. There are well lit and spacious dining rooms and lounges on both floors and these are warm and well furnished. The lounges are arranged in an informal way that promotes small groups of seats and not around the room in an institutional manner. All areas of the home are accessible to people using wheelchairs and there are appropriate aids and equipment provided to suit individual moving and handling Care Homes for Older People Page 23 of 32 Evidence: needs and help maintain peoples independence. We saw a range of moving and handling equipment, bathing and toilet aids in use and nursing beds for ease of movement. Staff records showed staff had received training on safe moving and handling techniques and using the equipment and records also indicated regular servicing to help make sure equipment was safe and in good working order. The home has infection control procedures in place and we saw staff on the units using protective aprons and gloves when attending to personal care and using appropriate clinical waste disposal. The bedrooms we saw were well furnished and people had brought personal items in to make their bedrooms more homely and individual. People are encouraged to personalise their bedrooms with their own possessions, furniture, ornaments, paintings and photographs from their own homes to help them feel at home. All but one the bedrooms are single occupancy and most have en suite toilets and showers. the double room may be used when relatives and carers wish to stay as well. There are also bathrooms with appropriate aids on each floor so people may have a bath if they prefer this or it suits their physical needs better. The home was clean and tidy with ample storage and smelt fresh and pleasant and fresh. Surveys we received back from people living there indicated that they found the home to be always fresh and clean. People commented positively on the high standards of cleanliness in the home. One told us Absolutely everything is done well, they always make sure your bed is comfortable and my room is clean and warm. Another person commented The cleanliness and upkeep is remarkable and the furnishing and accessories, tray cloths , napkins and such are very welcome and important details. The main laundry for the home is on site but away from the areas used by people living there. There is a smaller laundry on the ground floor of the home for personal laundry this was clean and well equipped. Changes are planned to be made to this to ensure there is a clean and dirty laundry area to improve infection control and reduce the risk of any cross infection. People commented positively on the laundry service and the speed with which their laundry was returned ready for me to wear. Care Homes for Older People Page 24 of 32 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. People living in the home are being supported by a well trained and experienced staff group and the robust recruitment procedures in operation mean that the safety and well being of people is promoted. Evidence: We looked at staff rotas on both the floors in the home and observed staff levels and deployment during the visit. The rotas were clear and done in advance and we could see that action was taken in good time to ensure that any training or holiday cover was provided. The rotas indicated that there were sufficient nursing, support and ancillary staff to make sure people received the nursing and physical care they needed and expected. There is a registered nurse on duty 24 hours a day and one, often 2 on each floor during the day shifts. There were 11 people living on the first floor on the day we visited and during the morning there were 5 staff supporting them including 2 registered nurses, this was a good ratio of staff to residents. On the ground floor there were 5 staff supporting the 16 people, which again was appropriate to the dependency levels. There were sufficient domestic staff to make sure that the home is kept clean and tidy. The staff we spoke with told us they enjoyed their work and one told us They are very good to work for, very flexible and support my family and childcare needs. Staff we spoke with told us that they had the time to spend with people and that I can Care Homes for Older People Page 25 of 32 Evidence: go home feeling I have been able to care for people in the way they want and I feel I have done my job well. Staff also indicated that they were well aware that the manager Expected very high standards of care but they felt Valued and supported to do that. Staff surveys we received indicated that staff felt there were usually enough staff to meet peoples individual needs and provide the support they wanted. Survey responses from staff included; I love working at Boarbank, the staff have a great relationship with service users, who often come back time and time again for respite. We are able to give holistic care to patients and families. A good ethos - a caring environment for staff and patients and consideration for everyone. People living there made positive comments to us about the staff in the home. Comments to us included; The whole atmosphere and running of the home is as near as one can get to living at home. The staff are mainly local people, long serving and giving us high standards of care and dedication, as individuals. There is very little staff turnover but we looked at recruitment records for the newest staff and these were in good order with completed application forms, all necessary references taken up and interview records kept. All staff had appropriate security checks in place, a Criminal Records Bureau (CRB) check and a check on the Protection of Vulnerable Adults (POVA) register to help make sure that they were appropriate to support vulnerable people. Regular checks are made on nursing registration status with their professional body. From talking with staff, from the comments and responses on their completed surveys and from looking at training records it was evident that staff have mandatory training and in other important areas such as palliative care. NVQ training programmes are well established with a high percentage of staff with NVQ level 2 or above in care. There is an on going and planned staff training programme, which we looked at and the records of completed training. We discussed with the care manager the importance of well planned training and they had already identified areas they wanted to improve, such as induction. Further Care Homes for Older People Page 26 of 32 Evidence: training on line via the Internet is being developed for staff to improve access to training on food and diet, dementia care and equality and diversity. We found that not all staff had received current infection control training and discussed this important training need with the clinical manager. This need had been noted and training was already being organised to bring staff up to date. We recommended that this be done quickly so staff were up to date with current best practice and a system in place to make sure such training could not be overlooked again. We could see that there was a highly motivated staff team and nursing staff were being supported to develop expertise and act as a link and resource in different areas of care, this included leg ulcer and wound care management, stroke training and social activities (exercise for the chair bound). Care Homes for Older People Page 27 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Boarbank Hall is well managed with systems, policies and procedures in place to help ensure that the health and safety of people living there and staff are promoted and protected. Evidence: Boarbank has an appropriately qualified and experienced registered manager, Sister Eileen Pollard in post. She is well supported by the care manager and nursing staff to help ensure the service is well run in the best interests of people living there. The care manager is a registered nurse, working in a management development role towards taking over the responsibilities of being the registered manager. She has achieved NVQ level 4 in management and has been working with the registered manager and staff developing improved systems for the home. She was able to show us the development plan she had developed for the service that was gradually being implemented. From what we saw, what staff and people living there told us and our surveys there Care Homes for Older People Page 28 of 32 Evidence: was evidence that the management style in the home is an open and inclusive one. The management team have a clear vision of maintaining and continuing to develop high standards of care in the home. Staff morale was seen to be good and staff are now having meetings and regular formal supervision and feedback on their practice. Staff we spoke to and survey responses also indicated this was the case. People we talked to said that they felt their views were wanted and that the manager and staff listened to what they had to say about their home. People living there and staff told us that the manager was approachable and that job satisfaction was high. We looked at a sample of records required by regulation and found these up to date and in good order. People are encouraged and supported to manage their own affairs and some people have support from their families and representatives. The home has quality monitoring systems in place to get the views of people living there and their families and to measure the homes success in meeting their aims and objectives. The manager uses a range of assessment methods including satisfaction surveys, staff meetings and residents meetings for specific topics and internal audits to monitor areas of practice. There are safe working practices in place to identify and minimise risks to staff and people living there and the home has a comprehensive range of policies and procedures to support current best practice. Policies and procedures have been subject to annual review and changes and updating as needed. Records showed equipment is maintained under service agreements. Records also indicate mandatory staff fire safety training is up to date. Care Homes for Older People Page 29 of 32 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 30 of 32 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 3 It is strongly recommended that the registered manager ensures that a complete and thorough pre admission assessment, undertaken by people trained to do so that covers all aspects of individual need set out in the National Minimum Standards, is always undertaken before a place is offered to a person to live in the home. We strongly recommend that infection control training for staff be done quickly so all are up to date with current best practice and a system should be put in place to make sure such training cannot be overlooked again. 2 30 Care Homes for Older People Page 31 of 32 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 32 of 32 - 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!