Care Home: Bolton Hall Care Home

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Key inspection report CARE HOMES FOR OLDER PEOPLE Bolton Hall Care Home Carrhead Lane Bolton On Dearne Rotherham South Yorkshire S63 8DA Lead Inspector Michael O`Neil Key Unannounced Inspection 5th May 2009 09:30 DS0000006473.V375194.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bolton Hall Care Home Address Carrhead Lane Bolton On Dearne Rotherham South Yorkshire S63 8DA 01709 881456 01709 891731 bolton.hall@craegmoor.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Yorkshire Parkcare Company Limited Jacqueline Pinches Care Home 80 Category(ies) of Dementia (80), Old age, not falling within any registration, with number other category (80), Physical disability (80) of places Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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,maximum number of places 80 Dementia - Code DE, maximum number of places, 80 Physical disability - Code PD, maximum number of place 80 The maximum number of users who can be accommodated is 80 2. Date of last inspection 16th June 2008 Brief Description of the Service: Bolton Hall is a purpose built two-storey care home with landscaped gardens and ample car parking space. The home is registered for 80 residents and provides both personal care and nursing care. There are local amenities within the immediate vicinity. The railway station, which serves Leeds and Sheffield, is a few minutes walk from the home, and the A1 motorway is approximately 10 minutes drive from the home. Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. This is what was used to write this report. Information about the home kept by the Care Quality Commission. Information returned to us by 13 people who live at Bolton Hall, 2 relatives, 8 staff and 2 health professionals who regularly visit the home. Prior to the visit the service had submitted an Annual Quality Assurance Assessment (AQAA) which detailed what the service was doing well, what had improved since the last inspection and any plans for improving the service in the next twelve months. The AQAA also included data as to when utilities and equipment at the home was serviced. Information from the AQAA is included in the main body of the report. An unannounced visit to the home. This was carried out by Michael ONeil, regulation inspector on 5th May 2009 and included talking to 7 staff and Jackie Pinches, registered home manager about their work and the training they have completed. And checking some of the records, policies and procedures the home has to keep. Elizabeth Slight, area manager of Yorkshire Parkcare Company Limited was also present for the majority of the visit. Some time was spent observing staff supporting people and talking with 12 people, a visiting health professional and 5 visiting relatives. We wish to thank the people living in the home, their relatives and the staff for their time, friendliness and co-operation throughout the inspection process. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 6 The overall feedback from all interested parties was that the care delivered by staff at Bolton Hall was good. Peoples comments included Residents are shown respect and kindness Since my relative has come here they are physically better and they are much happier. Health professionals said that they felt the care delivered at Bolton Hall was good. They added that staff at the home communicated well with them and generally they enjoyed good working relationships. People were treated with respect and dignity and addressed by their preferred name. Staff were observed interacting in a friendly and pleasant way. The home was clean and tidy and no unpleasant odours were noticeable. Staff said training opportunities were excellent. Staff, people and health professionals spoke very highly of the manager and said she was always available and very approachable. People said they saw her regularly and she often worked alongside care staff and provided hands on care. What has improved since the last inspection? What they could do better: Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 7 Peoples care plans need further attention so that they clearly reflect any changing health needs of the person. Some areas of the home are still in need of redecoration and refurbishment. 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. Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3. Standard 6 is not applicable to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were individually assessed prior to admission to ensure their needs could and would be met. EVIDENCE: Three care plans checked showed that people within the service had been assessed before moving into the home. Risk assessments and a plan of care reflected any specialist interventions. The assessment forms checked were detailed and fully completed. The manager and staff liaised with professionals, the person and their families to find out about peoples needs. People said they had visited Bolton hall for a trial period before deciding to stay at the home on a permanent basis. Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. People who use the service experience good outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Each person had a plan of care; in the main these included sufficient detail to ensure that all peoples changing needs were being met. Peoples health is monitored and arrangements for dealing with health issues were met with support from health professionals. People were treated with respect and said they were very happy with the care they received. Medication policies and procedures were well managed ensuring the safe administration of medication. Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 11 EVIDENCE: Three peoples care plans were checked. The peoples care plans contained details about the persons biography, personality and their preferences and choices. Overall we felt the standard of the plans were good and they did focus on the individual person. (Person centred) Staff and the manager said that they had been working hard to improve peoples care plans so they are comprehensive clear and concise. Risk assessments were included within the documentation and included moving and handling, skin integrity, and other risk factors. The care plans identified that a range of health professionals visited the home to assist in maintaining peoples health care needs. People said they had regular contact with their GP and other health professionals. There was evidence recorded to show that people and/or their relatives were involved in drawing up and reviewing the care plans. We did note one issue within the care plan documentation that did require staff attention. Staff informed us that one person was not able to eat or drink because of their medical condition. However the care plan stated that the person could have a small amount of fluid under close supervision. The care plan had not been amended and updated to include this persons changing health needs. We saw that people had received a good standard of personal care and looked clean and well dressed. The overall feedback from all interested parties was that the care delivered by staff at Bolton Hall was good. Individually: Peoples comments included Its a good home with good staff, all of them Residents are shown respect and kindness Things are better here the staff are great Staff take time and are patient with people Since my relative has come here they are physically better and they are much happier. Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 12 Health professionals said that they felt the care delivered at Bolton Hall was good. They added that staff at the home communicated well with them and generally they enjoyed good working relationships. Medication was securely stored in locked cupboards in a locked room Medication Administration Records (MAR) were up to date with no gaps. The Controlled Drugs Register was checked and this had been completed correctly with two signatures and a diminishing total. Staff said they had received medication training and records were seen of this training having taken place. We did find some handwritten MAR sheets did not contain General Practitioners or two members of staffs signatures alongside any directions regarding the dosage of the medication or the time the medication was to be given. This practice would help protect people and staff. People were treated with respect and dignity and addressed by their preferred name. Staff were observed interacting in a friendly and pleasant way. Staff took time to explain what task or support they were about to offer people. Overall we were very impressed with the professional yet friendly way in which staff assisted people in the home. We felt that this outcome for people at the home had improved since our last inspection. The manager confirmed that staff training on privacy and dignity has been updated and monitored on a monthly basis. Despite the inadequacy found in the care plan documentation the overall evidence shows that people at Bolton Hall experience good outcomes relating to health and personal care. This judgement is based on the evidence that the service has far more strengths than areas for improvement. The manager and area manager have also given assurances that the areas in need of improvement will be addressed and managed promptly. Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. People who use the 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 had a choice of lifestyle within the home and were able to maintain contact with family and friends ensuring that they continued to be involved in community life. People were able to make choices about daily living and be involved in some social activities. Meals served at the home were of a good quality and offered choice to ensure people receive a balanced diet. EVIDENCE: People said they were able to get up and go to bed when they chose and generally how they spent their day and evenings. They said they often went out with their families. Relatives said they were able to visit at any time and were made to feel very welcome. Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 14 A friendly, lively and welcoming feel was evident in Bolton Hall. People said that the home was a friendly place this was evident on the day of our visit. Some people said they enjoyed the activities available at the home, whilst other people said that they chose not to join in with the activities arranged. Activities were advertised around the home. The programme was comprehensive and included events within the home and some in the local community. People and their relatives said they had been actively involved in planning social activities and events held. They said there had been a significant improvement in the amount and type of activities arranged. People and staff said they had developed good links with the local school and churches. Some people attend a weekly lunch held at the church hall. The mealtime experience for people in the home was positive and had improved since the last visit we made to Bolton Hall. The tables were set nicely with condiments and matching crockery and when the meal was served people said The food is very good. Staff tried very hard to accommodate peoples choices for lunch. Staff were supporting people with their meal in a polite and discreet way. People said they were always offered a choice and asked what they wanted for their breakfast, lunch and teatime meals. People said they could now have their breakfast any time between 710am.This enables people to choose when they want to eat. People were very positive about this change. People said they were offered drinks on a regular basis throughout the day. Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints procedures were in place and people and their relatives felt confident that any concerns they voiced would be listened to. Staff had an understanding of the procedures to be followed should they suspect any abuse at the home, so helping to ensure that people were protected from abuse. EVIDENCE: People had been provided with a copy of the homes complaints procedure, which was also on display in the entrance hall of the home. This contained details of who to speak to at the home and who to contact outside of the home to make a complaint should they wish to do so. People said that they felt very comfortable in going to the manager knowing that any concerns they may have would be addressed without delay. Adult safeguarding policies and procedures were available to the staff. Staff said they had undertaken Safeguarding Adults training, and the manager was able to evidence this by producing the training records. Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,21,24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was clean, pleasant and hygienic although some areas of the home are in need of redecorating and refurbishing. EVIDENCE: The home was clean and tidy and no unpleasant odours were noticeable. People, and relatives said the home was always kept very clean. One ground floor unit had been recently refurbished to a very high standard. The unit was bright and pleasant. Pictures painted by the local school children were displayed on the walls, which helped to create pleasant corridor areas. Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 17 The high standard of the newly refurbished unit unfortunately shows up the tiredness of other parts of home. These areas are in need of refurbishment and redecoration. People also said that they would like these parts of the home refurbished. It is acknowledged that some rooms have been redecorated and new carpets have been fitted. However a more extensive programme of renewal is needed. The bathrooms and toilets in the home are still in need of refurbishment. The rooms are very stark and clinical with the floor coverings stained. The area manager said that within the last week a refurbishment plan has been developed and has been forwarded to the company for approval. Bedrooms checked were comfortable and homely. People said their beds were comfortable and bed linen checked was clean and in a good condition. Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff were employed in sufficient numbers and recruitment procedures promoted the protection of people. People receive care from a well-trained staff team. EVIDENCE: People spoke highly of the staff team and said staff always listened and acted on what they said. People said that staff were usually available when needed. Staff and the manager confirmed that staffing levels were adequate. Three staff files were checked at this visit. The files contained a range of information including two references and a declaration of health and identification. The staff had undertaken a criminal record bureau check (CRB), at the enhanced level. This confirmed thorough recruitment practices were in place, which was sufficient to safeguard people. Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 19 Staff said that they really enjoyed working at the home and got a lot of job satisfaction. We found that the staff were very enthusiastic and keen to improve the service further. The staff training records and the AQAA provided the evidence that the staff have all of the training needed to make sure that they can care for people. This included all of the mandatory health and safety training specific to the needs of people at Bolton Hall. Staff were able to talk about the various training courses that they had attended. Staff said training opportunities were excellent. A sample of development and training records were checked. These records showed when staff had completed mandatory training and refresher training. Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The procedures and ethos of the home ensure that the home is run in the best interests of people who use the service. The homes procedures promote the health, safety and welfare of people who use the service and the staff. EVIDENCE: Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 21 Jackie Pinches has many years experience within the nursing and caring profession. She has been registered manager of Bolton Hall since December 2008 but has worked at the home in a senior position for several years before becoming manager. Jackie has completed the Registered Managers Award. Staff, people and health professionals spoke very highly of the manager and said she was always available and very approachable. People said they saw her regularly and she often worked alongside care staff and provided hands on care. The manager and providers had ways in which to check out the quality of the service that they were providing. Regular staff meetings were arranged. The responsible individual visited the home on a regular basis, a report was written following the visits and any identified actions taken. People who use the service and their families met with the management of the home on a regular basis. Minutes of the last two meetings held in March and April 2009 were seen. Bolton Hall also has a person, resident at the home, who acts as the your voice representative for all people who live at the home. People said that their views and opinions are heard either directly to the manager or through their representative. This is a very positive initiative and people felt it worked well. A sample of monies that was looked after on behalf of people living at the home was checked. Records were kept and money tallied with the records. The AQAA provided information of the dates that equipment and systems within the home had been serviced and maintained. A fire risk assessment was in place at the home. Staff said they had received recent fire safety and other health and safety training .A sample of records showed that staff were receiving this statutory training. At the time of the visit fire exits were clear and hazardous products were safely stored in the home. This will promote the safety and welfare of the people. Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Peoples care plans must clearly reflect any changing health needs of the person. (Nutrition) Timescale for action 01/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The Medication Administration Records (MAR) should contain General Practitioners or two members of staffs signatures alongside any directions regarding the dosage of the medication or the time the medication is to be dispensed. The programme of renewal of the fabric and decoration to improve the environment should be continued. Toilets and bathrooms should be redecorated and refurbished and touches added to make them more domestic in style and so less clinical. 2. 3. OP19 OP21 Bolton Hall Care Home DS0000006473.V375194.R01.S.doc Version 5.2 Page 24 Care Quality Commission Yorkshire & Humberside Region PO Box 1254 Newcastle upon Tyne NE99 5AR National Enquiry Line: Telephone: 03000 616161 Email: enquiriesyorkshireandhumberside@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. 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