Care Home: Boroughbridge Manor & Lodge

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What the care home does well Not all of the essential standards were looked at, however it was the inspector`s view that the home was not performing well in any of the areas that were inspected. What the care home could do better: When we carried out our inspection we identified a number of areas where the home was failing to provide a good quality and safe service. We looked around the home and found it was dirty in some parts. People`s bedrooms smelt of urine and some carpets were badly stained. Dirty laundry was left in a bathroom and linen skips were full of soiled linen. Some flooring in people`s en-suites was heavily stained. Urine soaked underwear was found left in a hand wash basin of one en-suite that was inspected. A communal bathroom had smeared faeces on the hand wash basin and there was also a dirty, stained commode left in this room. A member of domestic staff was seen leaving this bathroom and confirmed to the inspector that it had `just been cleaned`. Early into the inspection it was clear that people`s care and welfare needs were not being met and that people were being put at significant risk of harm. One member of agency staff was overheard speaking to a resident inappropriately. This was reported to the manager who acted according to company policy and suspended this member of staff from duty immediately. People are left unsupervised for periods of time. Staff confirmed that they were rushed and did not have time to give people the proper care and attention they required. One member of staff said ` we never stop, I know I don`t give everyone what they need we are spread very thin, everyone gets the basics but nothing else. We don`t have enough on to do anything extra like activities. We sometimes can set a group up to play dominoes, but we cannot sit with them we just don`t have the time` . We saw that most people were either sat at the dining tables in the units or else asleep in the lounge areas. People said they were bored and had nothing to do. One person said `there`s nothing here, a chat would be nice but everyone is too busy today to stop.` Daily records of one person who displayed aggression towards staff were looked at. There was no risk assessment or care plan in place to instruct staff on how to manage this person`s aggression, and no referral had been sent to other agencies such as the mental health team to assist in dealing with this aggression. It was recorded in another persons care plan a significant weight loss, but it appeared that no action had been taken to address this. This person was on a food and fluid intake chart. However you could not determine how much the person had drank or eaten in a twenty four hour period as the chart did not record actual quantities. During theinspection this person was observed. The inspector saw a member of staff place a cup of tea in front of this person. The person could not reach the cup and the member of staff did not speak to the person or offer to assist them with the drink. An hour later the person was observed again. This time they were holding the cup, but unable to lift it to get a drink and the tea was now cold. Some of the care plans had not been updated or evaluated for several months. All care plans need to be audited, to make sure that people`s care is documented correctly, and staff have detailed information they can refer to. This is of particular importance given the amount of agency staff who are working in the home. We looked at how people`s medication was administered by the home. We found that people had not had some of there prescribed medication and that there was gaps in the recording of when people had been given there medication. Some skin preparations were not labeled correctly and some were out of date. The controlled drugs register was examined and it was found that some controlled drugs had not been returned to the pharmacy promptly and had remained in the home for over six months, when they were no longer required. During the inspection it was brought to the attention of the acting manager at the home that one person had `ran out` of some vital medication. Upon checking the records the medication had not been ordered for this person by the home. The medication systems and practices at the home were disorganised and in some cases unsafe and put people at potential risk of harm. Due to changes in legislation the current regulations we can enforce are going to cease from the 1st October 2010. We are aware that the provider will not be able to meet all of the requirements we have made during this inspection within this short timescale . As of the 1st October 2010 the Health and Social Care Act and associated regulations will be used to regulate services. We expect the provider to tell us how compliance with these new regulations will be achieved in the outcome areas where we have made requirements within this report. We will be monitoring their ongoing compliance under this new legislation. Random inspection report Care homes for older people Name: Address: Boroughbridge Manor & Lodge Roecliffe Lane Boroughbridge York YO51 9LW one star adequate service 03/02/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Bridgit Stockton Date: 0 9 0 9 2 0 1 0 Information about the care home Name of care home: Address: Boroughbridge Manor & Lodge Roecliffe Lane Boroughbridge York YO51 9LW 08456038218 01423326377 boroughbridgelodge@orchardcarehomes.com www.orchardcarehomes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Orchard Care Homes.Com Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 76 Number of places (if applicable): Under 65 Over 65 0 76 dementia old age, not falling within any other category Conditions of registration: 76 0 The maximum number of service users who can be accommodated is: 76 The registered person may provide the following category of service only: Care Home only Code PC 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 - Dementia Code DE Date of last inspection Brief description of the care home Boroughbridge Manor And Lodge can accommodate up to 76 older people, who require help with personal care including some people with mental health needs. The home is Care Homes for Older People Page 2 of 10 0 3 0 2 2 0 1 0 Brief description of the care home situated in its own private grounds, only a short distance from the market town of Boroughbridge. All of the bedrooms are well equipped and have en-suite facilities. People can access all floors by stairs or a passenger lift. At the inspection in February 2010, the acting manager told us the weekly fees range from £650 to £700. People pay extra for things like hairdressing, chiropody, newspapers, personal toiletries and dry cleaning. Information about the home, including the last inspection report can be requested from the manager. The Statement of Purpose and Service User Guide is also available on request. Care Homes for Older People Page 3 of 10 What we found: The unannounced inspection of Boroughbridge Manor and Lodge took place on the 9th September 2010. We decided to carry out this inspection of the service because of some concerns regarding poor standards of care that had been reported to us from various credible sources. North Yorkshire Social services also carried out a contract compliance inspection of this service on the same day. What the care home does well: What they could do better: When we carried out our inspection we identified a number of areas where the home was failing to provide a good quality and safe service. We looked around the home and found it was dirty in some parts. Peoples bedrooms smelt of urine and some carpets were badly stained. Dirty laundry was left in a bathroom and linen skips were full of soiled linen. Some flooring in peoples en-suites was heavily stained. Urine soaked underwear was found left in a hand wash basin of one en-suite that was inspected. A communal bathroom had smeared faeces on the hand wash basin and there was also a dirty, stained commode left in this room. A member of domestic staff was seen leaving this bathroom and confirmed to the inspector that it had just been cleaned. Early into the inspection it was clear that peoples care and welfare needs were not being met and that people were being put at significant risk of harm. One member of agency staff was overheard speaking to a resident inappropriately. This was reported to the manager who acted according to company policy and suspended this member of staff from duty immediately. People are left unsupervised for periods of time. Staff confirmed that they were rushed and did not have time to give people the proper care and attention they required. One member of staff said we never stop, I know I dont give everyone what they need we are spread very thin, everyone gets the basics but nothing else. We dont have enough on to do anything extra like activities. We sometimes can set a group up to play dominoes, but we cannot sit with them we just dont have the time . We saw that most people were either sat at the dining tables in the units or else asleep in the lounge areas. People said they were bored and had nothing to do. One person said theres nothing here, a chat would be nice but everyone is too busy today to stop. Daily records of one person who displayed aggression towards staff were looked at. There was no risk assessment or care plan in place to instruct staff on how to manage this persons aggression, and no referral had been sent to other agencies such as the mental health team to assist in dealing with this aggression. It was recorded in another persons care plan a significant weight loss, but it appeared that no action had been taken to address this. This person was on a food and fluid intake chart. However you could not determine how much the person had drank or eaten in a twenty four hour period as the chart did not record actual quantities. During the Care Homes for Older People Page 4 of 10 inspection this person was observed. The inspector saw a member of staff place a cup of tea in front of this person. The person could not reach the cup and the member of staff did not speak to the person or offer to assist them with the drink. An hour later the person was observed again. This time they were holding the cup, but unable to lift it to get a drink and the tea was now cold. Some of the care plans had not been updated or evaluated for several months. All care plans need to be audited, to make sure that peoples care is documented correctly, and staff have detailed information they can refer to. This is of particular importance given the amount of agency staff who are working in the home. We looked at how peoples medication was administered by the home. We found that people had not had some of there prescribed medication and that there was gaps in the recording of when people had been given there medication. Some skin preparations were not labeled correctly and some were out of date. The controlled drugs register was examined and it was found that some controlled drugs had not been returned to the pharmacy promptly and had remained in the home for over six months, when they were no longer required. During the inspection it was brought to the attention of the acting manager at the home that one person had ran out of some vital medication. Upon checking the records the medication had not been ordered for this person by the home. The medication systems and practices at the home were disorganised and in some cases unsafe and put people at potential risk of harm. Due to changes in legislation the current regulations we can enforce are going to cease from the 1st October 2010. We are aware that the provider will not be able to meet all of the requirements we have made during this inspection within this short timescale . As of the 1st October 2010 the Health and Social Care Act and associated regulations will be used to regulate services. We expect the provider to tell us how compliance with these new regulations will be achieved in the outcome areas where we have made requirements within this report. We will be monitoring their ongoing compliance under this new legislation. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 5 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 Peoples care plans must be kept up to date, to reflect their current needs. This is so staff understand what these needs are, and to make sure people get consistent care to meet these needs, regardless of who is on duty. THIS REQUIREMENT REMAINS OUTSTANDING FROM 31/03/2010 A NEW COMPLIANCE DATE HAS BEEN SET 30/09/2010 2 7 13 Risk to people must be 30/09/2010 properly assessed and monitored, taking into account peoples physical, social, mental and emotional needs. This is so that their plans of care identify precisely how risk is to be minimised, and what steps staff must take to make sure people remain safe. THIS REQUIREMENT REMAINS OUTSTANDING FROM 31/03/2010 A NEW COMPLIANCE DATE HAS BEEN SET Care Homes for Older People Page 6 of 10 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 3 8 14 Relevant information about people who live at the home must be passed on to relevant professionals when they are involved in a persons care. This will make sure peoples needs can be properly assessed and identified. THIS REQUIREMENT REMAINS OUTSTANDING FROM 31/03/2010 A NEW COMPLIANCE DATE HAS BEEN SET 30/09/2010 4 26 13 The proper equipment must 30/09/2010 be made available, and used, when handling or delivering soiled or infected linen. This is so the risk of cross infection is kept to a minimum. THIS REQUIREMENT REMAINS OUTSTANDING FROM 31/03/2010 A NEW COMPLIANCE DATE HAS BEEN SET Care Homes for Older People Page 7 of 10 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, 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 1 9 13 Arrangements must be put in 30/09/2010 place to ensure that all medicines, including skin care products, are administered according to the prescribers instructions. Using prescribed medicines correctly will help to improve or maintain peoples health and wellbeing. 2 9 13 Arrangements must be put in 30/09/2010 place to ensure that medicines ordering, receipt, administration and disposal records are made in an accurate and timely manner This will help to show that medicines received by the home are being looked after and given correctly 3 9 13 Effective systems must be put in place to ensure that sufficient medicines are always available in the home. This will help to ensure 30/09/2010 Care Homes for Older People Page 8 of 10 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 people can receive their medicines whenever needed. 4 19 12 All areas of the home must have a deep and thorough clean. To make sure people live in a clean and pleasant environment 5 27 18 Staffing numbers and skill mix of staff must be appropriate to the assessed needs of the service users, the size, layout and purpose of the home, at all times. In order that peoples assessed needs can be met fully and safely. 6 31 12 A detailed action plan with 30/09/2010 timesccales must be forwarded to the Commission detailing what actions have been taken to meet with these requirements made at inspection. This is so we can monitor the progress of the home. 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 30/09/2010 30/09/2010 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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