Care Home: Boucherne

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What the care home does well Three residents` care records were viewed during the site visit. All three contained a preadmission assessment detailing the resident`s care needs that had been undertaken prior to admission. Brief details of need were recorded in one of the care records with more detail recorded in the other two. Care plans were seen for individual needs, for example personal care, memory loss with risk assessments recorded as relevant for falls, nutritional assessment, self medication. All had been recently reviewed. Whilst there was no record of the care plan having been signed by the resident or their representative, one record did record that the care had been discussed with the family and consent obtained. Nutritional risk assessments were undertaken on admission and reviewed with weight monitoring also undertaken monthly. A resident spoken with during the visit to the service said they were satisfied with the care at the home and that staff came promptly when they called for assistance. Residents` access to healthcare services was discussed with a resident and a relative and confirmed from the care records. Residents were registered with the local GP practices who attended regularly on request. One resident`s care records viewed during the visit to the home confirmed they had received visits from their GP, optician, chiropodist and district nurse. The home had a medication policy and procedures for staff guidance that were seen during the visit to the service. The medication systems were discussed with a senior care assistant. Medication was supplied from the local supplying pharmacy in monitored dosage systems and individual containers. There were appropriate procedures for thereceipt and disposal of medication available that were seen to be well adhered to. Medication was given by senior care staff employed at the home who had received medication training and confirmed from the records viewed. Medication was stored in the staff office. Due to space restrictions, medication was stored in a locked wall cabinet and in another medicines cupboard that had a controlled drugs cupboard within it. Creams and dressings were stored on open shelving in the office. Each resident also had a separate named container that was stored in a locked kitchen cupboard. A drug fridge was also available and temperatures were monitored to ensure the safe storage of medicines requiring cold storage. The medication stocks and medicines administration records for three residents were examined. Records were completed accurately and in full and all medication was available as prescribed. The Controlled Drugs (CD) storage met requirements and a CD register was in use. Records were completed accurately and confirmed by two staff signatures as required. Staff were observed to be friendly and relaxed in their conversations with residents. A resident told us that their privacy, dignity and respect were upheld and said `there is a pretty high standard here`. Residents` personal care was observed to be provided in private. Rooms included personal items of furniture and lockable facilities for storage of valuable and medication in the event that a resident chose to self medicate. The home had a complaints procedure that was included in the contract of residency, a copy of which was provided to each resident. The record of complaints/compliments was viewed and contained numerous compliments from satisfied residents and/or their families. A record of concerns was made with the action taken. There had been only one documented for 2010. We were informed that there had been no written complaints received by the home in the previous twelve months. All residents and their relatives who completed surveys confirmed they were aware of the complaints procedure and who to speak to if they had a concern. One relative spoken with told us `the staff are brilliant` and a resident told us `It suits me here. it is more like home. There is nothing I am not happy about .` The home had safeguarding procedures in place and the records confirmed that updated training had been provided in safeguarding adults since the previous key inspection. This included training for non care staff which was good to see. The home had detailed policy and procedures for safeguarding adults and the Essex safeguarding procedures were seen to be available for staff guidance in the event of needing to refer an allegation. A whistle blowing policy was also available to support staff should they witness an allegation of abuse. The AQAA informed us that all staff receive safeguarding adults training and are aware of the procedures to be followed in the event of an allegation being made. There were twenty-two residents at the home. We were informed that the manager was on leave and there was one senior care assistant and four care assistants on duty. One care assistant also cooked breakfast and lunch and a cook came on duty in the afternoon to cook the evening meal. One domestic assistant was also on duty. The duty rota was seen and confirmed the staffing levels were as discussed. During the visit to the home, residents were observed to be well cared for and well supervised indicating that staffing levels were appropriate for their needs. The records confirmed that a total of twenty-two care staff were employed by the home of which thirteen had an NVQ level 2 qualification or above. This exceeds the 50% needed to meet the recommended standard.The AQAA informed us that staff turnover is low and recruitment is not therefore not a frequent requirement. During the visit to the home the recruitment files for three recently employed staff were viewed. All files included evidence that CRB Disclosures and evidence of identification had been obtained prior to appointment. The files also included staff contract/terms and conditions detailing their legal rights of employment. The AQAA informed us that a formal induction course is used for new recruits, to provide and record essential training. The senior care assistant stated that this was to Skills for Care standards, although the records were not available to confirm this. The AQAA informed us that in the previous twelve months updated training in medication had been provided and palliative care, dementia care and equality and diversity training had been provided. The training records were viewed and confirmed that training had been provided in manual handling, bereavement/palliative care, safeguarding adults, fire safety, care pl What the care home could do better: Care plans included a life story/social history that would enable staff to gain an understanding of the resident`s personal life and interests and hobbies. However this had not been completed in two of the records sampled. The agreement to the care plan had not been signed by the resident or their representative in any of the three care plans viewed.There was no list of staff signatures and initials held that would enable appropriate follow up in the event of an adverse incident. The CD register did not include the name and address on receipt and disposal of CD drugs as is required. Homely remedies were available for residents but there was no evidence of this having been agreed with the GP. The home`s recruitment procedures were inspected. From the three staff files viewed two had only one reference and there was no evidence that references had been verified. This does not ensure that systems are sufficiently robust to protect residents. Apart from one passport (poor quality), there was no photograph of staff as required under the regulations. The latest quality assurance report available was dated 2008 although copies of completed surveys were seen for 2009. There was no evidence of any quality audits being undertaken to monitor and improve the service. Random inspection report Care homes for older people Name: Address: Boucherne Holloway Road Heybridge Maldon Essex CM9 4SQ two star good service 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: Diana Green Date: 2 1 0 5 2 0 1 0 Information about the care home Name of care home: Address: Boucherne Holloway Road Heybridge Maldon Essex CM9 4SQ 01621855429 01621854478 cjtibballs@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Ann Carey Barlow Type of registration: Number of places registered: Conditions of registration: Category(ies) : Boucherne Ltd care home 24 Number of places (if applicable): Under 65 Over 65 24 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is 24 The registered person may provide the following categories 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 Date of last inspection Brief description of the care home Boucherne provides residential care for up to 24 older people. The home is situated in Heybridge, a short distance away from Maldon town centre. The period detached property has been extended to provide additional accommodation but has not lost its Care Homes for Older People Page 2 of 11 Brief description of the care home character and homely atmosphere. The home has a good-sized garden at the rear, with a smaller garden at the front. There is a small car park for visitors to the side of the property. Accommodation is on two floors, accessible by stairs, a passenger lift and a stair lift. Accommodation comprises both single and double rooms. All rooms seen were well furnished and decorated. Local shops are a short distance away and the home is on a bus route. The fees for the home, at the time of inspection in May 2010, ranged between £445 and £510 a week depending on the accommodation provided and the source of funding. Additional charges were made for newspapers, toiletries, hairdressing and private chiropody. For more up to date information contact the home directly. Care Homes for Older People Page 3 of 11 What we found: The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. This was an unannounced random inspection that took place on 21st May 2010. The inspection focused on health and personal care, complaints and safeguarding, staffing and management and administration. The report has been written using accumulated evidence gathered prior to and during the site visit, including the agencys Annual Quality Assurance Assessment (AQAA). The Annual Quality Assurance Assessment (AQAA), which is required by law to be completed by the service, is a self assessment that focuses on how well outcomes are being met for people using the service. This was completed by the registered provider and returned to us prior to the visit to the home. Information received in the AQAA provided us with some detail to assist us in understanding how the registered persons understand the services strengths and weaknesses and how they will address them. The inspection process included reviewing documents required under the Care Home Regulations. A number of records were looked at in relation to residents, staff recruitment and training, staff rotas and policies and procedures. Time was spent talking to residents, staff, and the Proprietor who were welcoming and helpful throughout the inspection. What the care home does well: Three residents care records were viewed during the site visit. All three contained a preadmission assessment detailing the residents care needs that had been undertaken prior to admission. Brief details of need were recorded in one of the care records with more detail recorded in the other two. Care plans were seen for individual needs, for example personal care, memory loss with risk assessments recorded as relevant for falls, nutritional assessment, self medication. All had been recently reviewed. Whilst there was no record of the care plan having been signed by the resident or their representative, one record did record that the care had been discussed with the family and consent obtained. Nutritional risk assessments were undertaken on admission and reviewed with weight monitoring also undertaken monthly. A resident spoken with during the visit to the service said they were satisfied with the care at the home and that staff came promptly when they called for assistance. Residents access to healthcare services was discussed with a resident and a relative and confirmed from the care records. Residents were registered with the local GP practices who attended regularly on request. One residents care records viewed during the visit to the home confirmed they had received visits from their GP, optician, chiropodist and district nurse. The home had a medication policy and procedures for staff guidance that were seen during the visit to the service. The medication systems were discussed with a senior care assistant. Medication was supplied from the local supplying pharmacy in monitored dosage systems and individual containers. There were appropriate procedures for the Care Homes for Older People Page 4 of 11 receipt and disposal of medication available that were seen to be well adhered to. Medication was given by senior care staff employed at the home who had received medication training and confirmed from the records viewed. Medication was stored in the staff office. Due to space restrictions, medication was stored in a locked wall cabinet and in another medicines cupboard that had a controlled drugs cupboard within it. Creams and dressings were stored on open shelving in the office. Each resident also had a separate named container that was stored in a locked kitchen cupboard. A drug fridge was also available and temperatures were monitored to ensure the safe storage of medicines requiring cold storage. The medication stocks and medicines administration records for three residents were examined. Records were completed accurately and in full and all medication was available as prescribed. The Controlled Drugs (CD) storage met requirements and a CD register was in use. Records were completed accurately and confirmed by two staff signatures as required. Staff were observed to be friendly and relaxed in their conversations with residents. A resident told us that their privacy, dignity and respect were upheld and said there is a pretty high standard here. Residents personal care was observed to be provided in private. Rooms included personal items of furniture and lockable facilities for storage of valuable and medication in the event that a resident chose to self medicate. The home had a complaints procedure that was included in the contract of residency, a copy of which was provided to each resident. The record of complaints/compliments was viewed and contained numerous compliments from satisfied residents and/or their families. A record of concerns was made with the action taken. There had been only one documented for 2010. We were informed that there had been no written complaints received by the home in the previous twelve months. All residents and their relatives who completed surveys confirmed they were aware of the complaints procedure and who to speak to if they had a concern. One relative spoken with told us the staff are brilliant and a resident told us It suits me here. it is more like home. There is nothing I am not happy about . The home had safeguarding procedures in place and the records confirmed that updated training had been provided in safeguarding adults since the previous key inspection. This included training for non care staff which was good to see. The home had detailed policy and procedures for safeguarding adults and the Essex safeguarding procedures were seen to be available for staff guidance in the event of needing to refer an allegation. A whistle blowing policy was also available to support staff should they witness an allegation of abuse. The AQAA informed us that all staff receive safeguarding adults training and are aware of the procedures to be followed in the event of an allegation being made. There were twenty-two residents at the home. We were informed that the manager was on leave and there was one senior care assistant and four care assistants on duty. One care assistant also cooked breakfast and lunch and a cook came on duty in the afternoon to cook the evening meal. One domestic assistant was also on duty. The duty rota was seen and confirmed the staffing levels were as discussed. During the visit to the home, residents were observed to be well cared for and well supervised indicating that staffing levels were appropriate for their needs. The records confirmed that a total of twenty-two care staff were employed by the home of which thirteen had an NVQ level 2 qualification or above. This exceeds the 50 needed to meet the recommended standard. Care Homes for Older People Page 5 of 11 The AQAA informed us that staff turnover is low and recruitment is not therefore not a frequent requirement. During the visit to the home the recruitment files for three recently employed staff were viewed. All files included evidence that CRB Disclosures and evidence of identification had been obtained prior to appointment. The files also included staff contract/terms and conditions detailing their legal rights of employment. The AQAA informed us that a formal induction course is used for new recruits, to provide and record essential training. The senior care assistant stated that this was to Skills for Care standards, although the records were not available to confirm this. The AQAA informed us that in the previous twelve months updated training in medication had been provided and palliative care, dementia care and equality and diversity training had been provided. The training records were viewed and confirmed that training had been provided in manual handling, bereavement/palliative care, safeguarding adults, fire safety, care planning and diabetes showing that staff were supported in attending mandatory training and training in care issues relevant to a care home for older people. The manager was on leave and a senior care assistant was in charge. However the proprietor did attend for part of the inspection. We were informed that the manager had completed the Registered Managers Award and continued to undertake updated training. This was also confirmed from the training records. From observation and an inspection of records, the home appeared to be well managed. The homes quality assurance policy and procedures were discussed with the proprietor who explained that an annual quality survey was circulated to residents and their families to obtain their views on how the service was doing. An action plan was produced from the outcome of the surveys and this was evidenced from a report dated 2008. We were informed that monthly meetings were held with the manager and proprietors to review issues and developments. The arrangements for handling residents monies were discussed with the proprietor. Neither the manager nor representative were appointee for any resident. All residents had a relative or representative to manage their finances on their behalf. No personal allowances were held on behalf of residents. We were informed that any additional charges were invoiced directly. The home had a health and safety policy and procedures in place for staff guidance that had recently been reviewed. The records confirmed that staff had attended health and safety training following appointment. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment (hoists, sling etc.) and utilities and there was evidence of appropriate weekly and monthly internal checks being carried out (e.g.checks on fire equipment, fire alarms and emergency lighting etc.). What they could do better: Care plans included a life story/social history that would enable staff to gain an understanding of the residents personal life and interests and hobbies. However this had not been completed in two of the records sampled. The agreement to the care plan had not been signed by the resident or their representative in any of the three care plans viewed. Care Homes for Older People Page 6 of 11 There was no list of staff signatures and initials held that would enable appropriate follow up in the event of an adverse incident. The CD register did not include the name and address on receipt and disposal of CD drugs as is required. Homely remedies were available for residents but there was no evidence of this having been agreed with the GP. The homes recruitment procedures were inspected. From the three staff files viewed two had only one reference and there was no evidence that references had been verified. This does not ensure that systems are sufficiently robust to protect residents. Apart from one passport (poor quality), there was no photograph of staff as required under the regulations. The latest quality assurance report available was dated 2008 although copies of completed surveys were seen for 2009. There was no evidence of any quality audits being undertaken to monitor and improve the service. 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 7 of 11 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 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 The name and address must be recorded on receipt and disposal in the controlled drugs register. This will safeguard residents. 31/05/2010 2 29 19 Two satisfactory references must be obtained for staff prior to appointment. This will safeguard residents. 31/05/2010 3 29 19 A recent photograph of all staff employed at the home must be available. This will safeguard residents. 11/06/2010 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 2 7 9 The agreement to the care plan should be confirmed by the signature of residents or their representatives. To ensure residents are safeguarded, homely remedies should be agreed with their GP annually. Page 9 of 11 Care Homes for Older People 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 3 9 To enable appropriate follow up in the event of an adverse incident, a list of staff signatures and initials should be available for staff designated to administer medication. To ensure residents are safeguarded, a system for verifying references should be established. 4 29 Care Homes for Older People Page 10 of 11 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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